Rotate-to-advance catheterization system

ABSTRACT

A method for visualizing the interior of a bodily passageway, comprising providing a visualization system comprising an endoscope comprising a rotatable drive collar configured for rotation relative to the endoscope; a disposable drive tube comprising an elongated tube having a deformable helical thread disposed on an exterior surface of the elongated tube, the elongated tube being configured for coaxial disposition about the endoscope; and a mount for releasably securing the drive tube to the drive collar; mounting the drive tube coaxially about the endoscope so that the drive tube is secured to the drive collar of the endoscope; inserting the visualization system into the passageway, with the helical thread being in a reduced profile configuration; transforming the helical thread into an expanded profile configuration; rotating the drive tube so as to bring together a site which is to be visualized and the visualization apparatus; and visualizing the passageway.

REFERENCE TO PENDING PRIOR PATENT APPLICATIONS

This patent application:

(i) is a continuation-in-part of pending prior U.S. patent applicationSer. No. 12/924,807, filed Oct. 5, 2010 by James J. Frassica for ROTATETO ADVANCE CATHETERIZATION SYSTEM;

(ii) is a continuation-in-part of pending prior U.S. patent applicationSer. No. 13/065,469, filed Mar. 22, 2011 by James J. Frassica forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM;

(iii) is a continuation-in-part of pending prior U.S. patent applicationSer. No. 11/363,990, filed Feb. 28, 2006 by James J. Frassica et al. forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM now U.S. Pat. No. 8,377,041;

(iv) is a continuation-in-part of pending prior U.S. patent applicationSer. No. 12/806,905, filed Aug. 24, 2010 by James J. Frassica et al. forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM now U.S. Pat. No. 8,366,674;

(v) is a continuation-in-part of pending prior U.S. patent applicationSer. No. 12/152,926, filed May 19, 2008 by James J. Frassica et al. forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM;

(vi) is a continuation-in-part of pending prior U.S. patent applicationSer. No. 12/467,836, filed May 18, 2009 by James J. Frassica et al. forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM now U.S. Pat. No. 8,343,040;

(vii) is a continuation-in-part of pending prior U.S. patent applicationSer. No. 12/467,907, filed May 18, 2009 by James J. Frassica et al. forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM now U.S. Pat. No. 8,235,942;

(viii) is a continuation-in-part of pending prior U.S. patentapplication Ser. No. 12/987,783, filed Jan. 10, 2011 by James J.Frassica et al. for ROTATE-TO-ADVANCE CATHETERIZATION SYSTEM now U.S.Pat. No. 8,317,678;

(ix) claims benefit of pending prior U.S. Provisional Patent ApplicationSer. No. 61/330,435, filed May 3, 2010 by James J. Frassica et al. forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM;

(x) claims benefit of pending prior U.S. Provisional Patent ApplicationSer. No. 61/330,442, filed May 3, 2010 by James J. Frassica et al. forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM; and

(xi) claims benefit of pending prior U.S. Provisional Patent ApplicationSer. No. 61/330,450, filed May 3, 2010 by James J. Frassica forROTATE-TO-ADVANCE CATHETERIZATION SYSTEM.

The eleven (11) above-identified patent applications are herebyincorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to apparatus and methods for catheterization andrelated treatments of the genitourinary and gastrointestinal passages ofmammals. More particularly, this invention relates to catheters,dilators, occluders, stents, suprapubic catheters, camera introducersand related medical devices subject to being proximally propelled anddirected for advancement and control in mammalian genitourinary andgastrointestinal passages.

BACKGROUND OF THE INVENTION

In most mammals, mucous membranes line all those passages by which theinternal parts communicate with the exterior, and are continuous withthe skin at the various orifices of the surface of the body. The mucousmembranes are soft and velvety, and very vascular, and their surface iscoated over by their secretion, mucus, which is of a tenaciousconsistency, and serves to protect them from the foreign substancesintroduced into the body with which they are brought in contact.

Mucous membranes are described as lining the two primary mammaliantracts, i.e., the genitourinary and the gastrointestinal—and all, oralmost all, mucous membranes may be classified as belonging to, andcontinuous with, the one or the other of these tracts.

Catheterization of any of these bodily passages may at times be usefulor necessary.

Urinary outlet problems have presumably been around for as long ashumans. History has the ancient Chinese using onion stalks to relievepeople of acute urinary retention. Literature refers to such problems asfar back as 206 B.C., more than 2000 years ago. The ancient Romans areknown to have used catheters, which are believed to have been firstinvented by Erasistratus, a Greek doctor in the third century B.C. TheRoman catheters were fine tubes made of bronze. The Roman gynecologistSoranus describes how catheters could be used to push stones out of theway and back into the cavity of the bladder, thus restoring urine flow.Excavations in Pompeii unearthed several bronze catheters. Theseinstruments were well constructed but relatively simple and showed thatcatheter designs changed little from the period of 79 A.D. until around1700 A.D.

However, during the 18^(th) and 19th centuries, catheter constructionbecame more complex, with an intensified search taking place for anappropriate substance that would be at once flexible, non-irritating andfunctional. England, France, and the United States all had individualsand companies deeply involved with urinary catheters during this period.Many variations were produced, but they all caused significant stress onthe patient when these rigid devices were pushed into the urethra. Thefirst practical breakthrough was made by the French using gum elasticcatheters—a catheter that would bend better in the urethral channel andnot scour the mucosa as much in the process.

Charles Goodyear improved upon what the French had produced when hesuccessfully vulcanized crude rubber. The problem of manufacturing aninstrument which was both sufficiently rigid to enable it to be pushedthrough the urethra and into the bladder, and yet flexible enough tonegotiate the path, had at last reached the point of practicality,notwithstanding its shortcomings. At that time, and even to this day, afunctional urethral catheter is frequently defined as being one that isflexible enough to negotiate the bends of the urethra and stable enoughto be pushed through the length of the urethral passage.

The French urologist J. J. Cazenave, with the hopes that his countrywould regain leadership in the catheter field, dedicated 25-30 years ofhis life improving the flexible durable catheter. This effort was in thelate 1800's and Cazenare's catheter, made of decalcified ivory, was adated device, but it nonetheless shows the consistency of the state ofthe art wherein catheters are pushed into and negotiated along theurethral passage toward the bladder.

During the past 300 years or so, intensified catheter developmentefforts were stimulated by professional pride, national pride andfinancial rewards. These efforts yielded many improvements, such aschanges to size, curve shape, materials of construction, smoothness,lubricants, coatings, combinations of materials, physical properties,chemical properties and more—yet all these improvements subscribed tothe basic principle of external push-to-advance catheter deployment.

The catheters of the prior art are generally large and stiff, difficultand uncomfortable to administer, and uncomfortable to wear for extendedperiods of time. There is a degree of skill, tolerance and patiencerequired from medical personnel installing the catheters that takes muchtime, training and practice to learn. The difficulty, discomfort, riskof injury and infection, inhibition and inconvenience of the methods andapparatus of the prior art results in the deprivation, for manypatients, of the freedom to work, play and travel as do unaffectedpeople.

The anatomy of the adult male urinary tract, as illustrated in FIG. 1,has a bladder 4 where urine is collected prior to exiting the body viathe urethra 6. The bladder 4 converges into the urethra 6 at a muscularexit called the bladder neck 5. Approximately the first inch of theurethra 6 lies within the prostate 7, which is a chestnut-sized gland.The next approximately half inch of the urethra passes through theexternal sphincter 8, which is the muscular flow valve that controls therelease of urine. The remaining six inches of the urethra 6 lie in aspongy zone, exiting the body at the meatus 9.

The normal process of emptying the bladder can be interrupted by twocauses. One is bladder outlet obstruction, and the other is failure ofthe nerves linking the bladder to the brain. The most frequent cause ofbladder outlet obstruction in males is enlargement of the prostate glandby hypertrophy or hyperplasia. In older males, it is not uncommon for aprogressive enlargement of the prostate to constrict the prostateurethra. This condition, known as benign prostatic hyperplasia (BPH),can cause a variety of obstructive symptoms, including urinaryhesitancy, straining to void, decreased size and force of the urinarystream and, in extreme cases, complete urinary retention possiblyleading to renal failure.

The most common surgical intervention for BPH, transurethral resectionof the prostate, or TURP, has a lengthy recovery period of up to oneyear, and presents a high operative risk for complications such assexual dysfunction. Up to 10% of those subjected to such surgery areleft with mild to moderate stress incontinence. Approximately 400,000patients in the United States, and approximately 500,000 patientsinternationally, were diagnosed in 1994 with BPH or cancer-inducedbladder outlet obstructions that were sufficiently severe to warrantTURP or alternative surgery, according to industry sources.

Because of the high costs, medical risks and quality of life compromisesassociated with TURP, new technologies have begun to challenge TURP'sposition as the standard treatment for severe BPH. Recently, the U.S.Food and Drug Administration (FDA) approved two drugs, tera zosinhydrochloride and rinasteride, to treat BPH. However, these drugsgenerally do not improve symptoms for six to nine months after treatmentbegins, and are not without side effects.

Urethral strictures are another cause of outlet obstruction, often dueto fibrous tissue growth resulting from reaction to catheters orcystoscopes or from injury, birth defects or disease, and are commonlytreated by urethral dilation, catheterization or surgery. Men withurethral strictures also experience a limited ability to urinate, whichmay cause extreme discomfort and, if left untreated, may causecomplications that necessitate catheterization. Approximately 50,000patients in the United States were diagnosed with recurrent urethralstrictures in 1994, according to industry sources. It is estimated thatapproximately 75,000 additional patients were diagnosed internationally.

Women suffer from urinary incontinence (UI) far more often than men andat a younger age, primarily because of the stress associated withpregnancy and childbirth, the shorter length of the female urethra, andthe absence of a prostate. The U.S. Department of Health and HumanServices (HHS) estimates that the involuntary loss of urine affectsapproximately 10 million Americans, of which 8.5 million are women.Seven million of these women are non-institutionalized, orcommunity-dwelling.

For women between the ages of 15 and 64, the prevalence of urinaryincontinence is estimated to range from 10 to 25 percent of thepopulation. For non-institutionalized persons over the age of 60, theprevalence of urinary incontinence ranges from 15 to 30 percent, withthe prevalence in women twice that of men.

The involuntary loss of urine can be caused by a variety of anatomicaland physiological factors. The type and cause of urinary incontinence isimportant to how the condition is treated and managed. The two broadcategories of urinary incontinence are urge and stress incontinence.Some people suffer from what is termed mixed incontinence, or acombination of stress and urge incontinence.

Urge incontinence is the involuntary loss of urine associated with anabrupt and strong desire to void. In most cases, urge incontinence iscaused by involuntary detrusor (the smooth muscle in the wall of thebladder) contractions or over-activity. For many people, urgeincontinence can be satisfactorily managed with pharmaceuticals.

The more frequently occurring stress incontinence is the involuntaryloss of urine caused by movement or activity that increases abdominalpressure. The most common cause of stress incontinence is hypermobilityor significant displacement of the urethra and bladder neck duringexertion. A less frequent cause of stress incontinence is intrinsicurethral sphincter deficiency (ISD), a condition in which the sphincteris unable to generate enough resistance to retain urine in the bladder.

Females, and males with no benign prostatic hyperplasia condition, mightalso have the inability to empty their bladder because of the nerveslinking the bladder to the brain. This condition is known as neuropathicbladder, and may occur in a wide variety of conditions which includespina bifida, multiple sclerosis, spinal injury, slipped disc anddiabetes. When these and other problems prevent the bladder fromeffectively controlling urine, there are a number of treatment options.They are catheters, dilators, occluders, and stents.

Indwelling Foley-Type Catheters

During continuous catheterization, an indwelling catheter is retained inthe bladder by a water-filled balloon. The indwelling catheter drainsurine continuously from the bladder into a bag which is attached to theleg or bed. The bag has a tap so that the urine can be emptied atintervals. The catheter is usually inserted by a doctor or nurse andchanged about every four to six weeks. But difficulty in placement hasalways been inherent in this design. This is due to the traditional“push to advance” technology which necessitates a relatively stiff,thick-walled catheter to traverse the delicate mucosal-lined urethra.

Often the French (unit of measurement) size of the catheter is dictatedby the need for stiffness to insert rather than the lumen size needed topass urine. A 14 French or smaller Foley catheter is rarely used becausecatheters of this size lack the column strength needed to push thecatheter along the full length of the urethra into the bladder.

The larger French Foley catheters are painful to place, uncomfortablewhen indwelling, and require a highly-skilled care provider to insert.

Intermittent Catheters

During intermittent catheterization, a simple catheter made of plastic,rubber, or metal is inserted by the patient or a helper for just longenough to empty the bladder completely, which is typically about oneminute. These temporary catheters are usually smaller in diameter andstiffer than an indwelling catheter of the same size. This stiffness canmake catheterization difficult in men because the male urethra is longand has an acute bend within the prostate. Also, when the externalsphincter is reached, the sphincter muscle will contract, making passagedifficult. Most patients learn to catheterize themselves and therebygain a large degree of independence. This process is repeated aboutevery 3-4 hours during the day and occasionally as needed at night.

Intermittent catheterization is mainly used by people who areincontinent due to a neuropathic bladder. Intermittent catheterizationmay also be utilized by people who cannot empty their bladder becausethe bladder muscle is weak and does not contract properly.

Suprapubic Catheters

In some patients, an alternate apparatus and method used to maintainlong term drainage of the bladder is the use of a suprapubic tube.

Suprapubic catheterization of the bladder is performed viatransabdominal puncture which enters the body above the pubic arch andis directed into the bladder using ultrasound or fluoroscopy to guidethe trocar introducer and suprapubic catheter. The trocar introducer isthen removed when proper catheter placement within the bladder isconfirmed, leaving the drainage catheter in place.

Long term drainage may require the fixation of the catheter at the skinusing standard adhesive-based interface components to address mechanicalfixation, infection control, and skin compatibility. The distal end ofthe catheter is commonly contained within the bladder by an inflatedballoon, or by winged-shaped tip configurations which expand within thebladder, or by pre-shaped curved catheter tips which curl to theiroriginal J-shape when stiffening wire is removed from the catheterlumen.

A problem with this form of distal end emplacement through the bladderwall is that it is only unidirectional; that is, it only resists theinadvertent pulling out of the tip of the catheter from the wall of thebladder, while allowing the catheter to freely pass further into thebladder, and to back out up to the point of the containment structure.This continuing catheter motion in and out of the bladder puncture sitemay irritate tissue and cause infection or other difficulty at thebladder-catheter interface. Urine is especially irritating to most partsof the human body that are outside of the urinary tract.

Dilators

Dilation is accomplished by pushing successively larger urethraldilation tubes through the urethra so as to increase the size of theurethral lumen, a procedure which is painful and traumatic to thepatient. Surgical treatment of strictures involves surgical risks aswell as complications, including infection, bleeding and restenosis,which frequently requires further treatment.

In general, the current art of dilators has also changed little over thepassage of time. A shaft with an increasing taper, bulbous structure, orenlarged end is pushed from without the passage to advance the toolthrough the restricted passage, thus forcing, by longitudinally-appliedpressure, the lateral expansion of the passage walls. Thispush-to-advance method necessitates a stiff shaft which has all the samelimitations as traditional catheters. Catheters inherently provide adegree of this dilatorial function to the extent that the passage isopened sufficiently to accommodate the catheter.

Occluders

Occluders are used in some cases to control incontinence. Occluders ofthe prior art are constructed and applied with the same push-to-advanceconcept as the catheters and dilators described above, and hence sufferfrom the same disadvantages. The basic occluder is a bulb or plug on ashaft which is inserted within the urethra to stop or prevent the normalflow of urine through the urethra, or driven all the way into thebladder, for example, and allowed to seat as a plug at the neck of theurethra to prevent the flow of urine from the bladder.

Stents

A stent is a tubular metallic mesh device that is implanted in to openand support a stricture so as to allow for urine flow. The stent body isbetween 3.5 cm and 6.5 cm in length, depending on the anatomy, and isexpandable by design to anchor in place. The stent, being a mesh, hasopenings that allow the tissue to grow through the wall, making removaldifficult and causing encrustation that reduces urine flow.

Intraurethral Valved Catheters

An intraurethral valved catheter is a device that is implanted tocontrol the flow of urine by means of an integral valve that is remotelyactuated. Since the entire catheter length is within the urethra, thechance for external infection is reduced. The anchoring mechanism ofcurrent designs is accomplished with balloons, or “petal-like”projections from the catheter. Both of the aforementioned designs arecomplicated to install and difficult to remove and, if the valve fails,leaves the patient in a painful and dangerous situation.

Patents in the Prior Art

There has been patent activity in the prior art indicatingdissatisfaction with the push-to-advance methodology. Catheters havebeen adorned with a wide assortment of spiral and threaded featuresdescribed as intended to ease the trauma and pain of what clearlyremained a push-in device. Alvord's U.S. Pat. No. 207,932, Peyret'sFrench Pat. No. 564,832, Hayes' U.S. Pat. No. 1,644,919, and Jacoby'sU.S. Pat. No. 1,888,349 are representative of these. In all cases, thesedisclosures fail to recognize that the basic push-to-advance techniqueis fundamentally flawed and should be abandoned, and fail to resolve thecritical features of structure necessary for rotational advancement as asubstitute for the push-to-advance method.

Other art reveals the use of spiral features for different purposes. Forexample, Spinosa's U.S. Pat. No. 3,815,608 discloses a catheter with athread designed to hold the urethral wall away from the shaft so as toallow urine to flow around the outside of the catheter. Such disclosureslikewise reveal a reliance on push-in methods, or an assumption thatsuch structures can be pulled out without regard to the spiral features,again failing to recognize rotation as a viable substitute for pushing,and failing to resolve the critical features of structure necessary foreffective rotational advancement.

As a further indication of the failure of the prior art to provideeffective improvements to traditional push-in methods, there is noapparent indication among the products commercially available, or in themedical practices known to the Applicants, that any of thesespirally-ornamented devices were ever found to be clinically viable.

Gastrointestinal Endoscopes

The current device used for inspection and treatment of the GI(gastrointestinal) tract is a flexible endoscope. This device takes ahigh level of skill to use, is difficult to maneuver and can be verypainful for the patient, due to the basic push-to-advance design thathas not changed since the device was invented in the early 1960's. Thedistal tip of the endoscope typically has the following parts:

-   -   1. a channel opening for suction and passage of accessories;    -   2. a light guide lens to distribute light from a fiberoptic        bundle to illuminate the visual field;    -   3. an objective lens to focus an image of the mucosa onto the        face of a fiber optic image bundle for transmission back to an        eyepiece; and    -   4. an air/water jet, which supplies air to inflate the organ        being observed, and water to clean off the image (i.e.,        objective) lens.

The so-called “bending section” is the distal end of the tube, rangingfrom approximately 8-15 cm long, which can articulate so as to steer thescope as it is pushed inward and is controlled by a cable mechanism thatis connected to control knobs on the proximal handle.

The so-called “insertion tube”, which makes up the rest of theendoscope's 60-150 cm length, is not capable of controlled deflection.It has a tailored bending flexibility and torque transmission which isof major importance in endoscope design. Most instruments have atwo-stage bending stiffness, i.e., the distal portion of the insertiontube is more flexible than the proximal portion. The flexibility of eachportion of the insertion tube requires extensive clinical testing toensure that the endoscope handles easily and produces a minimum ofpatient discomfort.

The colon is a tubular organ which runs from the cecum in the rightlower quadrant to the rectum. It is widest in the cecum and ascendingcolon and gradually narrows as one approaches the rectum. The colon isdivided into the following sections:

-   -   a. the cecum;    -   b. the ascending colon, which runs cephalad (towards the head)        from the cecum to the hepatic flexure;    -   c. the transverse colon, which runs from the hepatic flexure in        the upper quadrant to the splenic flexure in the left upper        quadrant;    -   d. the descending colon, which runs caudad (toward the feet)        from the splenic flexure to the left lower quadrant;    -   e. the sigmoid colon, which runs from the left lower quadrant to        the rectosigmoid junction; and    -   f. the rectum, which extends down to the anal canal.

The inner layer of circular muscle is present throughout the colon. Theouter longitudinal muscle in the wall of the colon is fused into threebands, the teniae coli. These bands start at the base of the appendixand run in the wall of the colon down to the rectum, where they diffuseinto the muscular coat. The three teniae cause the colon to have atriangular appearance endoscopically; this is especially prominent inthe ascending and transverse colon. The haustra are outpouchings of thecolon, separated by folds. In the descending colon the endoscopicappearance is often tubular.

Most experienced colonoscopists use similar endoscopic techniques. Airis introduced to inflate the colon, but as little as possible to preventoverdistension. The pushing pressure on the endoscope is gentle to avoidstretching the colonic wall or mesentery (the connective tissue thatholds the colon like a fan) which can cause pain, a vagal episode, or aperforation. The lumen is kept in view at all times; little or none ofthe examination is performed blindly, because the colonoscopist ispushing a stiff instrument through delicate tissue.

A variety of in and out maneuvers are used to “accordian” the colon onthe colonoscope, keeping the colonoscope as free of loops as possible.In the difficult colon, special maneuvers such as the creating of analpha loop in the sigmoid colon are used to pass the sharply angulatedsigmoid/descending colon junction. This maneuver may requirefluoroscopic guidance and training in the technique.

The colonoscope is advanced to the cecum under direct visualization. Thedetailed examination of the mucosa is usually performed as thecolonoscope is slowly removed from the cecum.

To inspect the whole length of the large intestine requires a highlyskilled practitioner, which makes the procedure costly. Even still, theprocedure can be very painful for the patient, making sedationnecessary. This is due to the inherent deficiencies in the“push-to-advance” design.

The small bowel, also known as the small intestine, is a long, coiledorgan located in the center of the abdominal cavity. The small bowel isabout 6 meters in length and it extends from the stomach and pyloricsphincter to the ileocecal valve, where it empties into the colon, orlarge intestine.

The small intestine is divided into the following sections:

-   -   a. the duodenum,    -   b. the jejunum; and    -   c. the ileum.

The walls of the small intestine are generally similar to, albeitsomewhat more delicate than, the walls forming other portions of thedigestive tract, such as the colon described above. The walls of thesmall intestine consist of a lining which is smooth in the duodenum, butwhich has folds and small projections thereafter, whereby to create thegreater surface area needed for the enhanced absorption of nutrients.

Although the small intestine is much longer than the large intestine(typically 4-5 times longer), it has a much smaller diameter than thelarge intestine. On average, the diameter of the small intestine of anadult human measures approximately 2.5 to 3 cm in diameter, whereas thelarge intestine typically measures about 7.6 cm in diameter.

Due to the significant differences in both the diameters and lengths ofthe small bowel and the large bowel, traditional endoscopes and themethods used in large bowel applications are not ideal for investigatingthe small bowel. This is because of the need to gather (or pleat) thesmall bowel onto the endoscope, which is difficult to accomplish usingtraditional endoscopes. In addition to the foregoing, and as discussedabove, the narrower small bowel also has a very delicate wall liningwhich is more susceptible to trauma than the lining of the colon.

Current approaches for accessing the small bowel generally utilizeballoon devices which are advanced to, and into, the small bowel andthen inflated. Once the device is inflated, the device is pulledproximally in order to gather a length of the small bowel onto thedevice, and then the device is deflated. The device is then advancedfurther into the small bowel and the process repeated as necessary so asto traverse the entire length of the small bowel. This process isextremely time-consuming for both the physician performing the procedureand the patient undergoing it. Keeping the length of the procedure asshort as possible is important since the longer the small bowel tissueis gathered, or “pleated”, on the device, the higher the chances fortissue damage or tissue necrosis. Similarly, the longer the procedure,the greater the risk of anesthesia-related complications.

In view of the foregoing, traditional “push-to-advance” endoscopicdesigns and methods are less than ideal for small bowel applications,and thus there is a need for a novel approach for endoscopicallyinvestigating the small bowel.

SUMMARY OF ISSUES WITH THE PRIOR ART

In summary, there are problems in making present push-in catheters,dilators, and occluders stiff enough for penetration and flexible enoughto make the turns without undue risk of trauma to the wall of thepassageway when being pushed in; and once installed, comfortable enoughto wear for an extended period of time. The problems with stentencrustation and removal are well known. Self-administration isinhibited by all of the short-comings of the prior art. Further injury,infection and discomfort can result from unskilled or impropertechnique. The problems with colonoscopy have been previously described.

The long history of push-in catheters/dilators and occluders hasgradually crystallized into an industry-wide, self-perpetuating,fundamental assumption that catheters are to be mainly pushed throughbodily passageways, albeit with some rotational easing. This “fact” isso widely perpetuated and pervasive in the commercially-availableproducts and medical practices as to have stifled original thinking inthis art. This, in spite of the well-recorded shortcomings of pain,trauma, risk of rupture, and failed, aborted or incomplete procedures,and the need for skilled practitioners and special equipment formonitoring and safeguarding against the inherent problems.

SUMMARY OF THE INVENTION

For the purposes of this disclosure, including the appended claims, theterms “distal”, “distally”, and “distal end”, as they relate to thedevices and methods described herein, refer to the end of the devicefurther from, or in the direction away from, a practitioner who might beapplying the device or method to the subject. Stated otherwise, theaforementioned terms refer to the end of the device closer to, or in thedirection towards, the subject's interior.

The terms “proximal”, “proximally”, and “proximal end”, as they relateto the devices and methods described herein, refer to the end of thedevice closer to, or in the direction towards, the practitioner whomight be applying the device or method, rather than to the subject.

Objects of the invention include providing and employing screw-basedmeans for rotational advancement and anchoring of catheters, probes,occluders, stents, and dilators into genitourinary and gastrointestinalpassageways such as the urethra, ureter, esophagus and fallopian tube,and for the emplacement of suprapubic catheters for draininggenitourinary organs such as the bladder, whereby the subject device isapplied through a natural body orifice or surgically created opening andis drawn through the passage by the longitudinal pull of a helix on thewalls of the passage or organ as the device is rotated. Objects of theinvention also include gathering, or “pleating”, bodily passageways(such as the small bowel) on to the screw-based means so as tofacilitate movement of the screw-based means relative to the bodilypassageways.

This technology is a radical departure from the 4000 year oldtraditional “push-to-advance” methodology previously discussed.

Indwelling and Intermittent Catheters

Flexible, thin-wall indwelling and intermittent catheters and relateddevices and delivery stylets, made possible by this rotate-to-advanceform of emplacement, are less traumatic and easier for the medicalpractitioner or patient to use. The catheter of the invention eliminatesthe problems of conventional devices by using helix or rotationaltechnology that provides controlled insertion and flexibility tonegotiate the urethra. The helix design accomplishes a pre-dilatation ofthe passageway at a steady rate that relaxes the sphincter and lessensor prevents spasm. Once placed, the device is anchored by the radialdisplacement and close pitch of the helix, preventing longitudinalmigration due to body movement or fluid flow.

In another embodiment, the helix is located on the shaft under aFoley-type balloon and disappears when the balloon is inflated. Theflexible, reinforced shaft need be only about half the wall thickness ofconventional Foley catheters, which means a smaller outer diameter (OD)catheter can be used. The helix advances the shaft and dilates theurethra as the catheter is inserted. Once the bladder is reached, theballoon is inflated with sterile water, and the helix is engulfed by theballoon. The process is then reversed to remove the catheter. Thistechnology fosters reduced costs for patient care, improved clinicaloutcomes and enhanced patient quality of life.

Continence Catheter with Valve

The continence catheter of the invention, indicated for bladder outletobstructions, is intended for BPH patients who are not able to, orchoose not to, undergo TURP. This embodiment of the invention allows theurethra in the area of the prostate to remain open. At the proximal(external) end of this catheter there may be a flow valve which can bedepressed or otherwise opened to empty the bladder. The catheter may beproduced as a sterile, single-use, disposable item that can be used onceand replaced as needed.

The same embodiment of the catheter of the invention provides a femalestress urinary incontinence (UI) sufferer with lifestyle benefits thatgreatly outperform absorbent products intended to manage this condition.

The patient simply inserts the catheter into the urethral opening androtates the shaft to advance the catheter into the bladder. This can bedone in the morning in the convenience of home. When the user needs tourinate, the valve end of the flexible shaft may be exposed through theclothing and the valve opened to empty the bladder. Since the device isnot removed and reinserted after each voiding, the risk of infection isreduced. At the end of the day, the catheter is easily removed anddisposed of.

Intraurethral Valved Catheter

The male or female intraurethral valved catheter of the invention isindicated for bladder control. This embodiment of the invention allowsthe flow of urine to be controlled by a valve mechanism that is withinthe catheter. This valve may be actuated directly by insertion of a toolsuch as a stylet, or remotely by using a magnetic field device.

The intraurethral device reduces the potential for infection byeliminating the external tubing which can be an entry path for bacterialcontamination. These catheters are typically 3.5 to 6.5 centimeters inlength, depending on the anatomy, and have the helical element of theinvention on the outer diameter of the body. The thread height of thehelix may vary over its length, as an aid to the advancement andretention characteristics of the device. The sidewall of the cathetermay be reinforced to resist collapsing due to contraction pressure. Thiscatheter may be inserted in the urethra under fluoroscopy, using adetachable flexible stylet which keys into the proximal end of thecatheter in a non-rotational fitment, and may be inserted in anoutpatient procedure using topical anesthesia.

Stents

The stent of the invention, indicated for bladder outlet obstructions,keeps the urethra open in the area of the stricture. The stent body maybe between 3.5 cm and 6.5 cm in length, depending on the anatomy, andhas a helical element on the outer diameter of the body to advance andretain the stent. The sidewall of the stent may have a reinforcementmeans to prevent collapsing due to prostate pressure. The stent can beinserted in the urethra under fluoroscopy, using a detachable flexiblestylet which keys into the proximal end of the stent body, and may beinserted in an outpatient procedure using topical anesthesia.

The stents of the invention are not susceptible to being incorporated bythe urethral mucosa in a manner preventing rotation, thereby permittinga lengthy period of emplacement and subsequent removal by the samerotational technique. The stent may also have a sufficiently largeinternal diameter, or lumen, to permit cystoscopies, thereby allowingexamination of the bladder without removing the stent.

Dilators and Occluders

Helically-adapted dilators and occluders of the invention are likewiserotatingly advanced and retracted; the helical element performing adilatory function to some degree. Dilators of respectively largerdiameters may be used to achieve a gradually more pronounced effect.

The rotational advancement means may be combined with thepush-to-advance methodology in any of these devices. In a dilator, forexample, a helically-equipped leader shaft extending distally of thebulbous portion of the device rotatingly advances the device up to thepoint that the helix passes out of the interior end of the passage; theremainder of the leader shaft then providing a guidewire that leads thebulb through the remainder of the passageway when the dilator is pushedfrom the proximal end.

Suprapubic Catheters

The adaptation of the invention to suprapubic catheters, used in aclassic transabdominal puncture for the drainage of the bladder or othergenitourinary organs, permits the helix on the distal end of thecatheter to be emplaced in the wall of the organ far enough so that thehelical vane extends from both sides of the organ wall, so that thelongitudinal sliding motion of the catheter into and out of the organ isinhibited by the helical vane. This reduces a source of irritation andassociated complications at the organ wall entry point.

The helically-adapted suprapubic catheter may be placed in the organusing ultrasound or fluoroscopy to visualize placement, by rotatinglyadvancing the catheter over a guidewire leading to the organ; theguidewire having been installed through a tubular access created byusing a cannula and trocar to reach the organ, the trocar and thecannula having been successively removed.

General Construction

Any embodiment of the invention may be radiopaque, or have radiopaquefeatures, markers or other components, permitting the use of fluoroscopyto monitor emplacement or removal of the device, or even the rotationalorientation and rotational movement of the device.

The thread element may be solid, hollow, or fluid-filled. It may taperin height at various locations to optimize advancement and anchoring.Embodiments or elements of the invention may be fabricated, molded,wound, extruded or otherwise constructed of non-toxic, non-corrosivematerials, or combinations of materials, e.g., a composite construction,that are otherwise tolerant of bodily fluids and/or durable whenimplanted in vivo. Such materials may include, but are not limited to,polyurethane, medical grade stainless steel, silicone, bicarbon,polytetrafluoroethylene, tantalum, titanium, or nickel-titanium alloy.Conversely, materials may be specifically chosen to be bioabsorbable soas to obviate the need for removal.

The devices of the invention may be enhanced with one or a combinationof the following coatings: a water-based hydrophilic; antibacterialcoatings such as nitrofurazone; bacteriostatic coatings such as silver;or other mediations to further enhance their clinical performance.

In one embodiment, a coating containing a particulate (e.g., talc) ormicrobead in a gel may be applied to the surface of the endoscope inorder to reduce or eliminate static friction (stiction).

Threaded Camera Introducer

The threaded camera introducer system, briefly stated, presents a novelmeans for the introduction of visualization sensors and other implementsinto and through the full length of a bodily passageway, e.g., the colon(for purposes of illustration, the threaded camera introducer systemwill sometimes hereinafter be discussed in the context of, and withspecific reference being made to, the colon; however, it should beappreciated that the threaded camera introducer system also hasapplication for use in other bodily passageways, e.g., the small bowel,and no limitation of use is intended to be inferred). The fundamentalstructure of the introducer, consistent with the rotate-to-advancestructure and methodology of the invention, is a large, soft, flexibleworm-like tubular device with a helix of soft, pliant threads whichtranslate rotational force at the proximal end to a pulling action onthe colon wall.

The hollow core or central lumen connects the distal and proximal endsof the tube. A camera head or other visual sensor can be introduced intothe device and arranged to “see” forward from the center of the bulboustip on the distal end. Light bundles or wires connected to the camerapass through the central lumen and out the proximal end of the device toan appropriate control and viewing apparatus.

The distal end of the device is gently urged into the rectumsufficiently far to engage the helix. The device is rotated from justoutside the point of entry, to slowly advance into and through theentire length of the colon to the cecum. The helical threads pull thedevice gently along the interior colon wall; the flexibility of thedevice allows it to easily negotiate the major turns of the colon. Thelarger threads at the distal end provide the greatest grip or pull, thesmaller threads closer to the proximal end contributing a lesser degreeof grip or pull. The device is removed using the same method in reverse.

As illustrated in the figures, the light bundles or cables may beencased in a flexible torque tube or assembly which provides orcontributes to the torsional strength necessary to rotatingly advanceand withdraw the device.

The interior wall of the main tubular device or introducer may beconfigured to contain the torque tube or vertebra in a non-rotationalmanner, such that torque applied at any place on the exterior wall ofthe introducer is transmitted to the torque tube and hence over the fulllength of the device.

Various embodiments and enhancements are possible, all within the scopeof the invention:

-   -   1. The helical thread or spiral extending the length of the        device may be used for auxiliary purposes, including to:        -   a) carry fluids into the colon/passage;        -   b) provide vacuum to the passageway itself, or vacuum within            the device to facilitate the advancement of the camera or            endoscope into the device;        -   c) convey light bundles or electrical wires for specific            purposes, and/or;        -   d) provide depth markers to assist the practitioner in            determining the general position of the device within the            body;    -   2. the spiral may also be inflated with a fluid during entry to        obtain full thread form and rotationally grip or fix the        catheter to the camera element, and then deflated to permit        non-rotational removal by pulling the device through the colon;    -   3. the video screen, or the image on the screen as seen through        the rotating camera introducer as it advances, may be        electronically processed to hold the image in a non-rotating,        stationary manner for the benefit of the person administering        the procedure;    -   4. the distal portion of the device may be relatively more        flexible to enhance trackability along the path of the        colon/passageway;    -   5. the device may have sufficient torque transmission capability        from the proximal to the distal end so the distal portion of the        device can be thus rotated at full length in the colon without        interior support;    -   6. the distal tip or zone may have a sufficient thread height to        grip the colon wall and provide the primary “pulling power” to        advance the device into the body and negotiate the turns, while        the somewhat lower thread height along the remainder of the        device is adequate to support rotational advancement without        drag and avoid bunching or gathering of the colon wall;    -   7. there are at least three methods of containing and        controlling this 160 cm long instrument to ensure it remains        within the operating field:        -   a) a dispensing device as shown in FIG. 34;        -   b) a straight tubular component; or        -   c) held by an assistant;    -   8. material of construction:        -   a) the main body may be produced from polyvinylchloride            (PVC) plastic and may be reinforced with wire or fabric;        -   b) the helix may be made of PVC and may be reinforced with            wire or otherwise;        -   c) a distal end window may be a flat, optically clear            plastic lens made from PVC, polycarbonate, or acrylic            plastic;    -   9. alternative uses:        -   a) variations on the introducer device within the scope of            the invention include full length tubes, or short sections            analogous to urethral stents, being emplaced in the colon by            the rotational structures and techniques of the invention            for temporary purposes such as to aid in the repair of a            damaged colon or a related abdominal injury or condition, by            providing a supplemental lining and/or form to the colon or            to a section of the colon;    -   10. camera with torque control umbilicus:        -   a) the camera body which houses both the camera and the            light source may be made of stainless steel or molded with a            dimensionally stable plastic such as polycarbonate;        -   b) the vertebrae which makes up the torque control umbilicus            may be made of a high strength thermoplastic or a metal such            as stainless steel or beryllium copper.

By means of the invention, the entire colon can be examined without theneed for a conventional colonoscope or endoscope, and without theattendant expertise, pain, medication, post-procedure recovery time, andcost. The means and method of the invention require less training andhave far greater likelihood of reaching the cecum (far end of the colon)than conventional tools and procedures.

Other body cavities and passageways may be similarly examined.

Among other things, the threaded camera introducer system can be used togather, or “pleat”, bodily passageways (such as the small bowel) on tothe threaded camera introducer system so as to facilitate movement ofthe threaded camera introducer system relative to the bodily passageway,whereby to facilitate visualization and/or treatment procedures.

The camera introducer catheter can be used in four different modes:

-   -   1. as an “introducer”, it includes the following characteristics        and benefits:        -   a) it conveys a camera assembly along the entire colon to            screen patients for polyps, lesions, cancer sights and other            maladies;        -   b) the entire colon can be examined without the need for a            conventional colonoscope/endoscope;        -   c) a total examination of the colon can be successfully            performed with significantly less manipulation technique,            pain, medication and post procedure recovery time;        -   d) it requires less training and has greater success in            reaching the cecum;        -   e) as a single-use disposable device, it allows the            expensive camera with its torque controlled umbilicus to be            used repeatedly without danger of sequential infections;        -   f) the procedure is less expensive when compared to the cost            of cleaning and repairing conventional endoscopes and            amortizing the cost of a costly video processing unit;        -   g) the procedure can be successfully performed by            less-specialized, less-expensive individuals; and        -   h) the “introducer” is supplied sterilized and ready for            use;    -   2. as a more “conventional style endoscope”—by adapting a        conventional endoscope to the structure and method of the        invention, the benefits of the invention are coupled with the        following conventional functions:        -   a) tip articulation;        -   b) air and water delivery;        -   c) suction of fluids;        -   d) illumination of passages;        -   e) imaging capability;        -   f) drug delivery; and        -   g) accessories (e.g., working tools).    -   3. as a “hybrid catheter” having some of the functions and        features of the more “conventional style endoscope” and/or the        “introducer” built into the device for procedure-specific        applications; also, it could be used in conjunction with, or        independent of, conventional endoscopic devices and accessories;        and    -   4. as a “transporter” or “introducer” to deliver a conventional        endoscope to any location of the colon or other passageway—this        may occur by:        -   a) providing a fluid-tight envelope for the endoscope; and        -   b) providing a means for the endoscope to exit the distal            end of the “introducer” to perform diagnostic/therapeutic            procedures normally done with the endoscope.

Thus, in one form of the invention, a conventional endoscope may bepositioned within an introducer having a generally tubular constructionwith a helical thread on the exterior, whereby rotation of theintroducer will cause the introducer, and hence the endoscope, to bemoved longitudinally within a bodily passageway. And in one preferredform of the invention, the endoscope may be coupled to the introducerwith a rotary coupling, such that the endoscope may remain free fromrotation while the introducer is rotated, whereby to stabilize theendoscope image while the introducer is rotated.

And in another form of the invention, a conventional endoscope may bemodified so as to provide helical threads along some or all of theexterior sidewall of the endoscope, such that upon rotation of theendoscope, the helical threads will move the endoscope longitudinallywithin a passageway.

Powered Drive

It should be appreciated that the system of the present invention can berotated either manually (e.g., by the surgeon rotating the catheter byhand) or, alternatively, the system can be power driven. In a preferredform of the present invention, a powered drive may be used to rotate thecatheter so as to allow an easier and more precise advancement of thecatheter into the bodily passageway or retraction of the catheter fromthe bodily passageway.

Lavage System

In one preferred form of the present invention, a lavage system may beprovided for clearing away debris from the front of the catheter. Inmany situations, the bodily passageway receiving the catheter may beobscured with debris, and it may be helpful to have a clear view of theanatomy when advancing an endoscope through the bodily passageway. Alavage system may be provided to flush debris from the cavity passagewaywith fluid during the insertion of the endoscope. By way of example, thelavage system may be used to break up and remove fecal matter from thecolon, thereby enabling a clearer view of the anatomy when the catheteris being advanced through the colon.

Some Preferred Forms of the Invention

In one preferred form of the invention, there is provided a method forvisualizing the interior of a bodily passageway at a remote location,the method comprising the steps of:

providing a visualization system for deployment in the bodilypassageway, the visualization system comprising:

-   -   an endoscope comprising a rotatable drive collar configured for        rotation relative to the endoscope;    -   a disposable drive tube comprising an elongated tube having a        deformable helical thread disposed on an exterior surface of the        elongated tube, the elongated tube being configured for coaxial        disposition about the endoscope; and    -   a mount for releasably securing the disposable drive tube to the        rotatable drive collar of the endoscope;    -   wherein the deformable helical thread has a sufficient        structural integrity, and a sufficient surface profile, such        that when the disposable drive tube is disposed in the bodily        passageway so that the deformable helical thread engages the        interior side wall of the bodily passageway, rotation of the        disposable drive tube will induce a relative movement between        the disposable drive tube and the side wall of the bodily        passageway;

mounting the disposable drive tube coaxially about the endoscope so thatthe disposable drive tube is secured to the rotatable drive collar ofthe endoscope;

inserting the visualization system into the bodily passageway at alocation remote from the site which is to be visualized, with thedeformable helical thread being in a reduced profile configuration;

transforming the deformable helical thread into an expanded profileconfiguration;

rotating the disposable drive tube so as to bring together the sitewhich is to be visualized and the visualization apparatus; and

using the visualization apparatus to visualize the interior of thebodily passageway.

In another preferred form of the invention, there is provided a methodfor visualizing the interior of a bodily passageway at a remotelocation, the method comprising the steps of:

providing a visualization system for deployment in the bodilypassageway, the visualization system comprising:

-   -   an endoscope comprising a rotatable drive collar configured for        rotation relative to the endoscope;    -   a disposable drive tube comprising an elongated tube having a        deformable helical thread disposed on an exterior surface of the        elongated tube, the elongated tube being configured for coaxial        disposition about the endoscope; and    -   a mount for releasably securing the disposable drive tube to the        rotatable drive collar of the endoscope;    -   wherein the deformable helical thread has a sufficient        structural integrity, and a sufficient surface profile, such        that when the disposable drive tube is disposed in the bodily        passageway so that the deformable helical thread engages the        interior side wall of the bodily passageway, rotation of the        disposable drive tube will induce a relative movement between        the disposable drive tube and the side wall of the bodily        passageway;

mounting the disposable drive tube coaxially about the endoscope so thatthe disposable drive tube is secured to the rotatable drive collar ofthe endoscope;

inserting the visualization system into the bodily passageway at alocation remote from the site which is to be visualized;

rotating the disposable drive tube so as to bring together the sitewhich is to be visualized and the visualization apparatus; and

using the visualization apparatus to visualize the interior of thebodily passageway;

transforming the deformable helical thread to a reduced profileconfiguration; and

withdrawing the visualization system from the bodily passageway.

In another preferred form of the invention, there is provided apparatusfor visualizing tissue, the apparatus comprising:

an endoscope comprising a rotatable drive collar configured for rotationrelative to the endoscope;

a disposable drive tube comprising an elongated tube having a deformablehelical thread disposed on an exterior surface of the elongated tube,the elongated tube being configured for coaxial disposition about theendoscope; and

a mount for releasably securing the disposable drive tube to therotatable drive collar of the endoscope;

wherein (i) the deformable helical thread is transformable between areduced profile configuration and an expanded profile configuration, and(ii) when in its expanded profile configuration, the deformable helicalthread has a sufficient structural integrity, and a sufficient surfaceprofile, such that when the disposable drive tube is disposed in thebodily passageway so that the deformable helical thread engages theinterior side wall of the bodily passageway, rotation of the disposabledrive tube will induce a relative movement between the disposable drivetube and the side wall of the bodily passageway; and

wherein the disposable drive tube is mounted coaxially about theendoscope so that the disposable drive tube is secured to the rotatabledrive collar of the endoscope.

In another preferred form of the invention, there is provided apparatusfor inducing relative movement between an endoscope and the side wall ofa bodily passageway within which the endoscope is disposed, wherein theendoscope comprises a rotatable drive collar configured for rotationrelative to the endoscope, the apparatus comprising:

a disposable drive tube comprising an elongated tube having a deformablehelical thread disposed on an exterior surface of the elongated tube,the elongated tube being configured for coaxial disposition about theendoscope; and

means for releasably securing the disposable drive tube to the rotatabledrive collar of the endoscope;

wherein (i) the deformable helical thread is transformable between areduced profile configuration and an expanded profile configuration, and(ii) when in its expanded profile configuration, the deformable helicalthread has a sufficient structural integrity, and a sufficient surfaceprofile, such that when the disposable drive tube is disposed in thebodily passageway so that the deformable helical thread engages theinterior side wall of the bodily passageway, rotation of the disposabledrive tube will induce a relative movement between the disposable drivetube and the side wall of the bodily passageway; and

wherein the disposable drive tube is mounted coaxially about theendoscope so that the disposable drive tube is secured to the rotatabledrive collar of the endoscope.

BRIEF DESCRIPTION OF THE DRAWINGS

Still other objects, features and advantages of the present inventionwill become readily apparent to those skilled in this art from thefollowing detailed description, wherein there are shown and describedpreferred and other embodiments of the invention by way of illustrationof the best mode contemplated for carrying out the invention. As will berealized, the invention is capable of other and different embodiments,and its several details are capable of modifications in various obviousrespects, all without departing from the invention.

FIG. 1 is an illustration of the lower abdominal anatomy of a malesubject, with the threaded portion of the catheter of FIG. 2 extendinginto the bladder;

FIG. 2 is a perspective view of a threaded catheter for a male;

FIG. 3 is a cross-sectional view of the threaded portion of the catheterof FIG. 2;

FIG. 4 is an illustration of the threaded end of the catheter of FIG. 1engaged in the urethra;

FIG. 5 is a perspective view of a threaded catheter for a female;

FIG. 6 is a cross-sectional view of the threaded portion of the catheterof FIG. 5;

FIG. 7 is a perspective view of a threaded catheter and a flexible shaftstylet with which it is installed;

FIG. 8 is a cross-sectional view of the tip of the catheter of FIG. 7,showing the non-rotational fitment that receives the tip of the styletof FIG. 7;

FIG. 9 is a perspective view of the tip of the stylet of FIG. 7 that isinsertable into the fitment of FIG. 8;

FIG. 10 is a diagrammatic, longitudinal cross-sectional view of athreaded balloon catheter showing the thread element inside the inflatedballoon, with lumens shown as dashed lines;

FIG. 11 is a cross-sectional view of the shaft of the catheter of FIG.10, showing the central drain lumen and the smaller inflation lumen;

FIG. 12 is a longitudinal cross-sectional view of the distal end of thecatheter of FIG. 10, showing the balloon contracted around the helicalelement;

FIG. 13 is a side elevation of a threaded dilator;

FIG. 14 is a side elevation of a threaded occluder;

FIG. 15 is a side elevation of another variation of a threaded occluder;

FIG. 16 is a perspective view of a threaded stent, dashed lines showingan internal sidewall reinforcement member and a bushing with a hexagonaldrive socket;

FIG. 17 is a cross-sectional view of the stent of FIG. 16;

FIG. 18 is a proximal end view of the stent of FIG. 16, with thehexagonal drive socket visible at the center;

FIG. 19 is a perspective view of a stylet, with a grip on the proximalend and a hexagonal drive tip on the distal end;

FIG. 20 is a perspective view of the hexagonal drive tip of the styletof FIG. 19;

FIG. 21 is a perspective view of a stent-follower with a helical elementat the distal end;

FIG. 22 is an enlarged, cross-sectional view of the distal end of thestent-follower of FIG. 21, showing the hidden portion of the bushing,with the hexagonal drive aperture in dashed lines;

FIG. 23 is a cross-sectional view of an intraurethral catheter with flowcontrol, showing the coiled wall reinforcement member acting as a springon the ball of the check valve;

FIG. 24 is an enlarged perspective view of a stylet tip for operatingthe check valve of the intraurethral catheter of FIG. 23;

FIG. 25 is a diagrammatic illustration of a suprapubic catheter emplacedthrough the abdomen, with the distal end anchored by the helical threadin the bladder wall;

FIG. 26 is a partial side perspective view of the helical thread of thesuprapubic catheter of FIG. 25, anchored by the helical thread in a holein the bladder wall;

FIG. 27 is a partial front perspective view of the suprapubic catheterof FIGS. 25 and 26 anchored in a hole in the bladder wall, the holebeing stretched and deformed to fit tightly about the tube and thread ofthe catheter;

FIG. 28 is a diagrammatic view of a trocar, cannula and guide wire usedto install the suprapubic catheter of FIG. 25;

FIG. 29 is a distal end view of the suprapubic catheter of FIG. 21,showing rotational orientation markers;

FIG. 30 is a front perspective diagram of a threaded camera introducercatheter advanced into the transverse colon area;

FIG. 31A is a partial side view of the distal end of the catheter ofFIG. 30, showing the larger thread height of the thread in the distalarea of the catheter's length;

FIG. 31B is a partial side view of the mid-section of the catheter ofFIG. 30, showing the reduced thread height of the thread in other thanthe distal area of the catheter's length;

FIG. 32 is a perspective view of a camera assembly with a video cameraor visual sensor head attached to a flexible torque tube or assemblywithin which run electrical cables and/or light bundles;

FIG. 33 is a partial cross-sectional view of the distal end of thepreferred embodiment of FIG. 31A, with the camera assembly of FIG. 32installed as it would be used;

FIG. 34 is a rotating container and dispensing device by which thecatheter of FIG. 30 may be managed and administered during applicationto a patient;

FIGS. 35-39 are schematic views showing various constructions for acamera introducer with rotary coupling;

FIGS. 39A-39D are schematic views showing another construction for acamera introducer with rotary coupling;

FIG. 39E is a schematic view showing a conventional endoscope withhelical screw threads formed on its exterior sidewall;

FIG. 40 is a schematic view of a conduit fitting formed in accordancewith the present invention;

FIGS. 41-43 are schematic views of an access device formed in accordancewith the present invention;

FIG. 44 is a schematic view of a power driven catheter system formed inaccordance with the present invention;

FIG. 45 is a schematic view of a catheterization system with a lavagefeature formed in accordance with the present invention;

FIG. 46 illustrates a preferred prostatic stent construction;

FIG. 47 illustrates a preferred fallopian catheter construction;

FIGS. 48-55 show various preferred configurations for the helical threadconstruction;

FIGS. 56-62 show a camera introducer system examining the small bowel inaccordance with the present invention;

FIGS. 63-74 show a camera introducer system comprising a powered helicaldrive;

FIG. 75 is a schematic view showing a novel visualization system formedin accordance with the present invention;

FIG. 76 is a view like that of FIG. 75, except with selected portions ofthe view being shown in section;

FIG. 77 is a schematic view showing the endoscope of the novelvisualization system of FIG. 75;

FIG. 78 is an enlarged view of a portion of the endoscope shown in FIG.77;

FIG. 79 is an enlarged sectional view of a portion of the endoscopeshown in FIG. 77;

FIG. 80 is another enlarged sectional view of a portion of the endoscopeshown in FIG. 77;

FIG. 81 is a view taken along line 81-81 of FIG. 80;

FIG. 82 is an enlarged view of a portion of the structure shown in FIG.81;

FIG. 83 is a schematic view showing the disposable drive tube of thenovel visualization system of FIG. 75;

FIG. 84 is a partial sectional view of the disposable drive tube shownin FIG. 83;

FIG. 85 is an enlarged view of a portion of the novel visualizationsystem of FIG. 75;

FIGS. 86 and 87 are schematic views showing a bayonet mount used toreleasably secure the disposable drive tube to the endoscope; and

FIG. 88 is a schematic view showing how the novel visualization systemof FIGS. 75-87 may comprise deformable helical threads.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

To those skilled in the art, the invention admits of many variations andappellations in apparatus and methodology. By way of example, there isprovided, in accordance with the present invention, a rotate-to-advancestructure and methodology applicable to a range of medical devices thathave heretofore relied entirely or substantially on a push-to-advancetechnique for penetration of bodily passages. Such devices includecatheters, dilators, and occluders for mammalian genitourinary orgastrointestinal passages such as the urethra or ureter for the usualpurposes associated with such devices where no incising or rupture ofpassage walls or membranes is intended.

Catheters

Referring now to FIGS. 1, 2 and 3, a threaded catheter 101 for males ismade up of a tube 102 with an external thread 103, attachable to a flowcontrol device 104. Tube 102 is extruded from a polyurethane material,has an inside diameter of 0.06 inches, an outside diameter 103 d of0.125 inches, and is approximately 13 inches long. The durometer, asmeasured on the smooth, outside wall of the tube, is 85 Shore A. Distalend 105 is closed off, with its tip rounded to a uniform radius of about0.06 inches. Proximal end 106 of tube 102 is cut off square and attachedto flow control device 104. Tube 102 is sufficiently strong such thatwhen the majority of its length is contained within the urethra, it willwithstand and transmit torque, as applied by finger force at the lowerend of the tube external of the urethra, to the thread.

Referring to FIGS. 2 and 3, external thread 103 is formed from a stripof polyurethane material with a rectangular cross-section of width 103a, 0.05 inches, and height 103 b, 0.032 inches, and continuouslyattached over its length to tube 102, starting 0.2 inches from distalend 105 and extending four complete turns around tube 102 in a clockwisedirection towards proximal end 106 at a uniform pitch 103 c of 0.25inches, resulting in a four-turn thread or helix about one inch long.

It is readily apparent from the dimensions of FIGS. 2 and 3 that thethread height 103 b of catheter 101 is greater than twenty percent (20%)of the 103 d thread diameter. This relative height is desirable toexpand and penetrate the longitudinal folds of the urethra to asufficient depth to achieve a useful grip by the thread.

The diameter of the helix formed by thread 103 of catheter 101 isreferred to as thread diameter 103 d, and is equal to two thread heights103 b plus the outside diameter 102 d of catheter tube 102 or, in thiscase, 2 times 0.032 inches plus 0.125 inches, or approximately 0.19inches. The circumference C of the helix formed by thread 30 iscalculated as Π (pi) times thread diameter 103 d or, in this case, 3.14times 0.19, or approximately 0.6 inches.C=π×thread diameter 103d

The ratio R of thread pitch 103 c, 0.25 inches, to the circumference ofthread diameter 103 d, at 0.6 inches, is much less than 1 to 1, therebyimproving the leverage of the screw thread for converting rotation intolongitudinal pulling power, as compared to ratios larger than 1/1.

$R = \frac{{thread}\mspace{14mu}{pitch}\mspace{14mu} 103c}{C}$

The shoulders of thread 103 have a radius of 0.015 inches. In smallquantities, thread 103 may be attached to tube 102 by wickingtetrahydrofuran (THF) solvent under the thread using a fine hollow tube.Catheter 101 may be molded in large quantities with thread 103 being anintegral part of the molded structure.

Referring to FIG. 4, two drainage ports 107, connecting to lumen 108,are oval in shape, the major axis of the oval being parallel to the axisof tube 102 and about 1.5 times the minor axis, which is about equal tothe diameter of the lumen. The two ports are configured 180 degreesapart radially, and spaced longitudinally to fit between the turns ofthread 103.

Both ends of thread 103 are tapered from zero to full height in one-halfturn of the helix, to facilitate gentle, gradual displacement of urethrawall 2 by thread 103 when catheter 101 is rotated clockwise foradvancement into the urethra and counterclockwise for retraction. Thedifference between thread height 103 b and pitch 103 c shown in FIG. 3is sufficient that the urethra wall 2 does not bridge between adjacentturns of thread 103, but rather is only displaced in a manner closelyconforming to the cross-section of thread 103, thereby providing thelongitudinal grip on urethra wall 2 for advancing and retracting thecatheter.

Referring to FIG. 1, catheter 101 is shown in proper position fordraining bladder 4, after it has been advanced through the urethra 6until the helix passes out of the urethra into the bladder.

It is apparent from the anatomy shown in FIG. 1 that thread 103 must belimited in length to be advanced to any point above the sphincter 8, sothat the sphincter may contract directly onto the smooth, round,exterior of tube 102, thereby preventing leakage around the tube, andfurther constraining catheter 101 from migrating or being forced out ofthe urethra by pressure from urine in the bladder. It is furtherapparent from the anatomy shown in FIG. 1 that there is a limit to thelength of thread 103 on a catheter that can be advanced to a positionabove the sphincter 8, not more than about six turns within the optimalrange of thread pitch, and still fit within the bladder 4 withoutinterference. A limited length of thread 103 also localizes the area ofpulling force to the upper end of catheter 101, thereby assuring thatthe trailing length of the catheter is drawn, not pushed, through thepassage.

A useful alternative embodiment of catheter 101 incorporates the recitedexternal thread 103 for rotational advancement, but provides for thecentral lumen to connect to or terminate in a straight-through oraxially-aligned drainage port at the distal tip of the catheter, similarto the most basic conventional catheters. This is likewise useful fordrainage and also enables the insertion or passage of guidewires orother devices where specific procedures require it.

Referring next to FIGS. 5 and 6, a threaded catheter 111 for females,similar to catheter 101 for males, is made up of a tube 112 with athread 113, attachable to a flow control device 114. Tube 112 isextruded from polyurethane material, has an inside diameter of 0.063inches, an outside diameter 112 d of 0.125 inches, and is approximatelyseven inches long. The durometer, as measured on the smooth, outsidewall of the tube, is 85 Shore A. Distal end 115 is closed off, with itstip rounded to a uniform radius of about 0.06 inches. Proximal end 116of tube 112 is cut off square and attached to flow control device 114.Tube 112 is sufficiently strong such that when the majority of itslength is contained within the urethra, it will withstand and transmittorque, as applied by finger force at the lower end of the tube externalof the urethra, to the thread or helix.

Referring to FIGS. 5 and 6, thread 113 of catheter 111 is formed from astrip of polyurethane material with a rectangular cross-section of width113 a of 0.05 inches and height 113 b of 0.10 inches, attached to tube112 starting 0.2 inches from distal end 115 and extending four turnsaround tube 112 in a clockwise direction towards proximal end 116 at auniform pitch 113 c of 0.25 inches, resulting in a four-turn thread orhelix about one inch long.

It is readily apparent from FIGS. 5 and 6 that the thread height 113 bof catheter 111, at 0.10 inches, is much greater than twenty percent(20%) of tube diameter 112 d, at 0.125 inches. This relative threadheight is desirable in order to expand and penetrate the longitudinalfolds of the female urethra sufficiently far to achieve a useful grip bythe thread.

Similar to the description of threaded catheter 101, the diameter 113 dof the helix formed by thread 113 is equal to two thread heights 113 bplus the diameter 112 d or, in this case, 2 times 0.10 plus 0.125, orapproximately 0.33 inches. The circumference C of the helix formed bythread 113 is calculated as Π (pi) times the thread diameter 113 d or,in this case, 3.14 times 0.33, or approximately 1.0 inches. The ratio Rof thread pitch 113 c, at 0.25 inches, to the circumference C, at 1.0inches, is again much less than 1 to 1, thereby improving the leverageof the thread for converting rotation into longitudinal pulling power ascompared to larger ratios.

The shoulders of thread 113 have a radius of 0.015 inches. Catheter 111may be constructed or fabricated by the same means as catheter 101.

Referring to FIG. 5, two side drainage ports 117, connecting to lumen118, are oval in shape, the major axis of the oval being parallel to theaxis of tube 112 and about 1.5 times the minor axis, which is aboutequal to the diameter of the lumen. The two side ports 117 areconfigured 180 degrees apart radially, and spaced longitudinally to fitbetween the turns of the thread.

Referring to FIGS. 5 and 6, the ends of thread 113 are tapered from zeroto full height in three-quarters turn of the helix, to facilitategentle, gradual displacement of the urethra wall by the thread when thecatheter is rotated clockwise for advancement and counterclockwise forretraction. The difference between width 113 a and pitch 113 c issufficient that the urethra wall does not bridge between adjacent turns,but rather is displaced in a manner closely conforming to the profile ofthe thread, thereby providing the longitudinal grip on the urethra wallfor advancing and retracting the catheter, in the same manner as thethread of catheter 101 of FIGS. 2 and 3.

The optimal position for threaded catheter 111 for draining the bladderof a female subject is where it is advanced through the urethra untilthe thread passes out of the urethra into the bladder, similar to howcatheter 101 is illustrated in FIG. 1, but for females.

A detailed method for the self-administration of the appropriaterespective threaded catheter 101 or 111, or other similar threadeddevices, will now be explained.

First, the user assembles materials including a sterile threadedcatheter 101 or 111, a container for urine, soap and water, a watersoluble lubricant (if the catheter is not pre-lubricated), a mirror (forfemales), and tissues. The user will then wash the hands and urethralopening with soap and water, squeeze out a small amount of lubricantinto clean tissue, dip the distal end tip of the catheter into thelubricant, and manually engage the tip of the catheter into the urethralopening (the mirror may be helpful for females to assist in locating theopening).

The user will then gently push and turn the catheter in, far enough toengage the thread about one full turn with the urethra, and then gentlyrotate the tube of the catheter in the direction of the thread,preferably clockwise, to advance the catheter into the urethra untilurine appears in the tube. The user then pauses to drain the bladder,directing the urine into the container, then resumes rotation of thecatheter until it is no longer advanced by the rotation, indicating thatthe thread of the catheter has passed into the bladder and the catheteris in proper position.

The user then places a flow control device on the proximal end of thecatheter and empties the bladder periodically as required. The catheteris removed, when appropriate, using similar precautions for cleanlinessand containment, by rotating the catheter in a direction opposite thedirection of insertion, presumably counterclockwise.

Referring next to FIGS. 7, 8 and 9, another embodiment of the inventionis illustrated by a catheter 121, which is made up of tube 122 withthread 123 applied in the form of a helix, and utilizing a flexibleshaft stylet 131 as an insertion and retraction tool. Stylet 131 has agrip 133 at its proximal end for turning the device. Tube 122 isconfigured with non-rotational fitment 124 (FIG. 8) near its distal end125 so that stylet 131 can be inserted through the tube's proximal end126, passed up through lumen 128 of tube 122, and the tip 134 of stylet131 engaged with fitment 124 in a manner that allows rotation of grip133 in one direction to rotate catheter 121 for advancement into theurethra, and in the other direction for retraction.

The flexible shaft 132 of stylet 131 is sufficiently strong such thatwhen it is fully inserted into catheter 121, shaft 132 will withstandand transmit torque, as applied by finger force to knurled knob grip 133external of the urethra, to the thread 123. Stylet 131 is removed aftercatheter 121 is installed, and reinserted for retracting the catheterwhen required.

Fitment 124 is an elongated collar with a multi-faceted interior wall,securely anchored within tube 122, and configured to receive, in anon-rotational relationship, tip 134. Tip 134 is configured with acorresponding elongated, multi-faceted exterior shape and rounded end,to readily enter fitment 124. Stylet tip 134 and fitment 124 can bealternatively configured and connected by various means to provide anon-sliding, as well as non-rotational, connection.

Referring next to FIGS. 10, 11 and 12, a threaded Foley-type catheter141 of the invention is made from polyurethane material. Catheter 141comprises a flexible tube 142 with an axial drainage lumen 148 runningfrom a drainage port 149 to its proximal end 146 a, and a thread 143applied to its external surface near its distal end 145 in the manner ofthe threaded catheters previously described. Catheter 141 has athin-walled inflatable elastic balloon 150 encasing the helical thread143 and sealed to tube 142 above and below (i.e., distal and proximalto) the thread 143. Drainage port 149 is located above (or distally)from balloon 150. A smaller inflation lumen 151 within tube 142communicates between inflation port 152 (within the envelope of balloon150) and the distal end 146 b of the catheter. Lumens 148 and 151 areisolated from each other, as indicated by FIGS. 11 and 12.

Balloon 150, when uninflated, is normally contracted tightly abouthelical element 143 as illustrated in FIG. 12, and may be inflated as inFIG. 10 by injecting fluid through lumen 151 and into the balloon cavity153. The flexible tube 142 is of sufficient torsional strength towithstand and transmit rotational finger force, applied at the proximalend of tube 142, to thread 143.

Dilators and Occluders

Referring now to FIGS. 13, 14 and 15, a dilator 201 and occluders 211and 221 are similarly constructed by configuring the upper end 205 of aflexible shaft 202 with a tapered bulb 204 near its distal end, anddisposing thereon one or two sections of thread 203. These threads aresimilar to thread 103 on catheter 101 of FIGS. 2 and 3, wherein theheight of the thread is at least twenty percent (20%) of the diameter ofthe shaft 202, and the ratio of thread pitch to the circumference of thethread diameter at any given point on the bulb or shaft is less than oneto one (1/1). The ends of threads 203 are tapered for ease of advancingand retracting, again similar to the threaded catheter of FIGS. 2 and 3.

Dilator 201, of FIG. 13, is configured with multiple turns of thread 203extending over both ends of tapered bulb 204, and is used to dilate aconstricted passage by being rotatingly advanced and retracted throughthe obstructed area of the passage in the same fashion as the threadedcatheters of the invention.

Occluder 211, of FIG. 14, is configured with two sections of thread 203,leaving the midsection or bulbous portion of tapered bulb 204 smooth andround in order to provide a uniform occluding surface. This occluder isused to plug or constrict a passageway at an interior point, beingrotatingly advanced to and retracted from that point in the same fashionas the threaded catheters of the invention.

Occluder 221, of FIG. 15, is configured with two sections of thread 203,the lower or proximal end thread 203 being disposed on the shaft 202below the tapered bulb 204, leaving the lower tapered end of bulb 204smooth and round in order to provide a uniform occluding surface. Thisoccluder is used to plug a passageway at the interior end neck orentrance, being rotatingly advanced until the tapered bulb passesentirely through the passage while the lower thread remains engaged inthe passage, and being then rotatingly retracted to seat the taperedbulb against the neck of the passage. The occluder is then rotatinglyretracted when appropriate.

Stents and Intraurethral Valve Catheters

Referring now to FIGS. 16-18, a threaded urethral stent 301 made frompolyurethane material has a tube 302 with an external thread 303 ofuniform pitch. Thread 303 is similar to thread 103 of catheter 101 ofFIGS. 2 and 3, wherein the height of the thread is at least twentypercent (20%) of the diameter of the shaft 302, and the ratio of threadpitch to the circumference of the thread diameter is less than one toone (1/1). The ends of thread 303 are tapered for ease of advancing andretracting through a passage. There is an interior shoulder 304 (FIG.17) at the distal end 305 of the stent, and a bushing 307 (FIG. 17) ofrelatively harder material disposed proximal to interior shoulder 304.Bushing 307 has a tapered interior wall 308 extending from the bushing'sfull diameter at one end to a uniform hexagonal aperture 309. Coiledsidewall reinforcement member 310 is secured within stent 301intermediate bushing 307 and interior shoulder 304. Alternativeembodiments may have a section of the thread being tapered to a lesserheight or no height, so as to provide a “waist” for gripping by amuscular zone such as the prostate or sphincter. Also, reinforcementmember 310 could be configured or molded into the sidewall of tube 302.

Referring now to FIGS. 19 and 20, a stylet 331, similar to the stylet131 of FIG. 7, has a flexible shaft 332 with a grip 333 at the proximalend for turning, and a hardened hexagonal tip 334 at the distal endwhich closely fits into aperture 309 of stent 301 in a non-rotationalmanner for emplacement of the stent by the method of the invention. Theflexible shaft 332 of the stylet is sufficiently strong such that whentip 334 is inserted into aperture 309, the shaft will withstand andtransmit torque, as applied by rotational finger force at grip 333, tothread 303.

Referring now to FIGS. 21 and 22, a threaded stent-follower 341 has aflexible tube 342, the lumen 347 (FIG. 22) of which is sized to acceptthe ready insertion of tip 334 and shaft 332 of stylet 331 of FIG. 19.Tube 342 is of sufficient torsional strength to accept and transmitrotational finger force applied at its proximal end 346 to its distalend 345. A thread 343 of uniform pitch, and not more than six turns, isapplied to the external surface of tube 342 near distal end 345. Thread343 preferably conforms to the same twenty percent (20%) “rule” ofthread height to tube diameter, and the ratio of thread pitch to threadcircumference of less than one to one (1/1), as thread 103 in FIGS. 2and 3 as described above. The ends of thread 343 are tapered for ease ofadvancing and retracting.

Referring to FIGS. 17 and 22, bushing 351 (FIG. 22) has a uniformhexagonal aperture 352 which is the same size as aperture 309 in bushing307 of stent 301, and a tapered interior wall 353 extended from its fulldiameter at its proximal end to aperture 352. Bushing 351 also has anexternal tapered tip 354 at its distal end. Bushing 351 is affixedwithin the distal end 345 of tube 342, with tip 354 protruding, suchthat the distal end 345 of stent-follower 341 mates with aself-centering action with the proximal end of stent 301 when the twodevices are brought into contact with approximate axial alignment. Whenstent-follower 341 and stent 301 are thus mated, tip 334 (FIG. 19) ofstylet 331 may be extended through aperture 352 (FIG. 22) and intoaperture 309 (FIG. 17), thereby locking stent 301 and stent-follower 341into a fixed rotational relationship. In this condition, the rotation ofthe proximal end of stylet 331 and stent-follower 341 causes theconcurrent rotation of stent 301, whether to rotatingly advance orretract the stent. Stylet 331 may be withdrawn and stent-follower 341rotatingly retracted, leaving stent 301 positioned at any useful pointwithin a passageway.

Referring now to FIG. 23, threaded intraurethral catheter 361, shown incross-section, incorporates means for flow control. The catheter has atube 362 made from a section of extruded polyurethane tubing material,with thread 363 of uniform pitch and not more than six turns applied toits external surface. Thread 363 preferably conforms to the same twentypercent (20%) “rule” of thread height to tube diameter, and ratio ofthread pitch to thread circumference of less than one to one (1/1), asthread 103 in FIGS. 2 and 3 as described above.

Alternative embodiments may have a section of the thread being taperedto a lesser height or no height, to provide a “waist” for gripping by amuscular zone such as the prostate or sphincter. Also, a portion ofreinforcement member 370 could be configured or molded into the sidewall of tube 362.

There is an interior shoulder 364 at the distal end 365 of catheter 361,and a bushing 367 of relatively harder material disposed proximal tointerior shoulder 304. Bushing 367 has a tapered interior wall 368extending from the bushing's full diameter at one end to a uniformhexagonal aperture 369.

A coiled sidewall reinforcement member 370 and a check ball 371 aresecured between interior shoulder 364 and bushing 367 so that coiledmember 370 holds ball 371 in compression against the upper (proximal)end of bushing 367 in the manner of a check valve, whereby to preventoutward (proximal) flow through the lumen 372 of the stent. Coiledmember 370 may be compressed by upward movement of ball 371, therebyopening the check valve to flow.

Referring next to FIGS. 19, 21, 23 and 24, alternate hexagonal tip 384for stylet 331 has a slightly concave proximal end 385 and flutes 386.When used in conjunction with stent-follower 341 to actuate the checkvalve of catheter 361, tip 384 is adapted to be inserted throughaperture 369 of catheter 361 to push ball 371 upward against coil member370, thereby opening the check valve function and permitting outwardflow of fluid through flutes 386 and aperture 369 and then into andthrough stent-follower 341.

Suprapubic

Referring now to Figs. and 25-29, the threaded suprapubic catheter 401of FIGS. 25 and 26 is constructed with a flexible tube 402, with a lumen408 connecting axial ports at the proximal end and the distal end, andan external thread 403 of uniform pitch applied at its distal end. Asdescribed previously for catheter 101 of FIGS. 2 and 3, the ratio ofthread pitch 403 c to the circumference of thread diameter 403 d is muchless than one to one (1/1). Tube 402 is of sufficient torsional strengthto accept and transmit rotational finger force, applied at the proximalend, to the distal end. The ends of thread 403 are tapered for ease ofadvancing and retracting the catheter through the abdomen and into thebladder wall.

Referring to FIGS. 26 and 27, relative thread height 403 b, as apercentage of tube diameter 402 d, is greater than in the case ofcatheter 101 of FIGS. 2 and 3; preferably greater than fifty percent(50%). This is because suprapubic catheter 401 is being advanced by therotation of thread 403 along an unlined path through the abdomen, andbeing anchored against longitudinal displacement by the engagement ofpitch 403 c of thread 403 in a hole pierced into the wall of organ 31that must encompass tube 402 plus thread 403 passing through the planeof the organ wall 31. This is distinguished from the longer grippingsurface available in a lined passageway as is the case for the catheter101 of FIG. 4.

Referring to FIG. 28, the method by which suprapubic catheter 401 isdeployed is conventional to the extent that trocar 421 and cannula 422are used with ultrasound or fluoroscopy to create the path throughabdomen wall 21 into the bladder organ 31; trocar 421 is removed andtemporary guidewire 423 is then inserted through cannula 422, extendingfrom outside the abdomen wall 21 to inside the bladder organ 31. Cannula422 is then withdrawn, leaving guidewire 423 as a connecting path,extending from outside the body, passing through the abdominal wall 21,and into the bladder organ 31.

Suprapubic catheter 401 is then threaded over the proximal end ofguidewire 423, and gently started into the abdomen wall 21 with arotating motion of about one turn until thread 403 is firmly engaged.The catheter is then rotatingly advanced along the guidewire through theunlined pathway in the same manner as other threaded devices of theinvention, until thread 403 penetrates the wall of organ 31 about onefull turn, as determined by ultrasound, fluoroscopy or equivalent means.The distal end of catheter 401 is then secured in a non-rotatablefashion to abdomen wall 21 using conventional adhesive means orequivalent means, thereby locking thread 403 at the distal end of thecatheter in position in the wall of organ 31. Guidewire 423 is thenwithdrawn. Threaded suprapubic catheter 401 is then available for use.

Referring to FIG. 29, radiopaque markers 411, embedded at select pointsdisplaced along the perimeter of thread 403, provide the capability forexternal detection and monitoring (through fluoroscopy or other means)of the orientation and movement of the distal end of the catheter.

Threaded Camera Introducer

Referring next to FIGS. 30, 31A and 31B, threaded camera introducercatheter 500, suitable for an average size adult's colon or other bodilypassageway, consists of a bulbous tip 501 connecting to a soft, flexibletube 502 which is about 5 feet long with a tube diameter 502 d of 1inch. Lumen 508 extends from the interior face of a window 511 on thedistal end of tip 501, through tip 501 and tube 502 to the proximal endof tube 502.

Still referring to FIGS. 30, 31A and 31B, for a lower GI(gastrointestinal) application, external thread 503, preferably withuniform pitch 503 c of 1.75 inches, begins at the edge of window 511,tapering from nothing to a height of about 0.5 inches, and continuingproximally for about 8 inches or more along tube 502.

An alternative embodiment of the introducer 500 may have a relativelydiminutive tip, but maintain an external thread of equal or greaterheight and total circumference. Another variation of introducer 500 mayhave thread 503 applied only to the introducer's distal end, the threadterminating after a few turns, e.g., approximately 8 inches or less,analogous to catheter 101 of FIG. 2.

A thread major diameter in the range of 0.5 inches to 2.5 inches, andmore preferably 1 inch to 2 inches, is desirable to expand and engagethe walls of the colon of the adult intestinal tract to a sufficientdepth to achieve a useful grip by the thread in accordance with therotate-to-advance technology of the invention. For other bodilypassageways, other thread major diameters may be used. If desired, atrailing portion of the helical thread may have a lower thread height.The relatively lower thread height of the continuing thread may beemployed to assist in the rotational advancement of the trailing lengthof the device without exerting undue forward pressure on the distal end.

It will be further apparent, consistent with the techniques, structureand methodology of the invention, that the thread pitch 503 c, isdesigned to produce the necessary leverage to translate rotationaleffort at the proximal end to a forward force greater than the frictionagainst the wall of the colon or other bodily passageway. Simple vectoranalysis confirms this result.

Referring to FIG. 32, a camera assembly 520 consists of camera 521, withlight lens 522 and image lens 523, attached to a flexible, hollow,jointed spine 531. A cable harness 541, connected to camera 521, passesthrough spine 531, extending out the proximal end and connecting to thenecessary power, control and display equipment. Spine 531 is constructedof a chain of vertebrae 532, connected by universal joints which combineflexibility with torsional strength.

Referring to FIG. 33, camera assembly 520 is shown installed in cameraintroducer catheter 501, with camera 521 secured within tip 501 by setscrew 512, so that the camera views forward through the window. Thecamera assembly and catheter are combined here as a camera introducersystem.

Referring next to FIG. 34, rotating container and dispensing system 550consists of drum 551 with axial opening 552 around which handle 553 isrotatably attached. Catheter 501 is rotatingly dispensed duringapplication by holding handle 553 and rotating drum 551 while catheter501 is being rotatingly advanced in the subject colon or other bodilypassageway.

As will be realized, the invention is capable of other and differentembodiments, and its several details are capable of modifications invarious obvious respects, all without departing from the invention. Theobjects and advantages of the invention may be further realized andattained by means of the instrumentalities and combinations particularlypointed out in the appended claims. Accordingly, the drawings anddescription are to be regarded as illustrative in nature, and not asrestrictive.

Threaded Camera Introducer with Rotary Coupling

In FIGS. 30-34, there is shown a threaded camera introducer catheter 500which may be used to position a camera assembly 520 within a bodypassageway, e.g., the colon. Among other things, a significant advantageof the helical camera introducer is the ability to stabilize thevisualization apparatus (e.g., endoscope) within the bodily passagewayto improve visualization diagnostic yield. By way of example, thehelical camera introducer can help stabilize a colonoscope duringwithdrawal around flexures in the mucus-lined colon, which reduces therisk of missing significant pathologies.

However, with the aforementioned assembly of (i) threaded cameraintroducer catheter 500 and (ii) camera assembly 520, camera assembly520 is secured, both longitudinally and rotationally, to threaded cameraintroducer catheter 500, e.g., by means of set screw 512 (FIG. 33).Thus, when threaded camera introducer catheter 500 is rotated so as toadvance camera assembly 520 within the colon or other bodily passageway,camera assembly 520 is also rotated. This presents two issues.

First, if camera assembly 520 is rotated during passage through a bodilypassageway, e.g., the colon, the image observed by the medicalpractitioner (on either a video monitor or through an eyepiece) willalso be rotating. This rotation can make it difficult for the medicalpractitioner to effectively use the visualization provided by the cameraassembly during passage through the colon. At the very least, thisrotation makes it difficult for the medical practitioner to maintaintheir sense of direction (i.e., up/down/left/right) during deployment.This latter point is significant, since the medical practitionerfrequently relies on their sense of spatial orientation in order tonavigate a tortuous passageway such as the lower GI tract. Stabilizingthis image electronically requires complex additional circuitry and/orcomputer software in an already-costly scope and image processor system.

Second, if camera assembly 520 is rotated during passage through thecolon, the camera assembly's umbilage connections (e.g., light,electrical, fluid, etc.) become complex. By way of example but notlimitation, in such a situation, water connections to the distal end ofthe endoscope must be designed to rotate freely about the axis of theendoscope, with a leak-proof seal, etc. Again, this can add significantcost and complexity to an already costly and complex endoscope system.

The aforementioned issues are addressed by a new threaded cameraintroducer catheter which has a rotary coupling at its distal and/orproximal ends (and, if desired, at one or more intermediate locations)which is free to rotate relative to the body of the introducer. This newcamera introducer catheter is installed over the distal end theendoscope, with the distal and/or proximal ends (and, if desired, one ormore intermediate portions) of the endoscope being secured to the rotarycoupling. Due to the fact that the endoscope is attached to the cameraintroducer catheter by means of the rotary coupling, the cameraintroducer catheter is free to rotate about its axis while the endoscoperemains rotationally stationary.

This new arrangement allows the camera introducer catheter to rotateabout its longitudinal axis, whereby to advance or retract theintroducer (and hence the endoscope) within a bodily passageway, e.g.,the colon; at the same time, however, inasmuch as rotation of the cameraintroducer catheter is not transferred to the endoscope, the endoscope(and hence all of its associated input and output connections) remainsrotationally stationary. As a result, the new camera introducer catheterallows the medical practitioner to hold the proximal end of theendoscope in the customary manner, i.e., rotationally fixed, whiledeploying the endoscope using the rotate-to-advance methodology of thepresent invention. This is a significant advance in the art.

Looking next at FIGS. 35 and 36, there is shown a threaded cameraintroducer catheter 600 which may be used to position a camera assemblyor endoscope 700 within the colon or other bodily passageway.

In one form of the invention, camera introducer catheter 600 ispreferably substantially the same as the camera introducer catheter 500described above, except for the provision and use of one or more rotarycouplings 605 which will hereinafter be discussed in further detail.More particularly, camera introducer catheter 600 generally comprises atube 610 upon which is formed a helical thread 615. Tube 610 hassufficient rigidity that rotation applied to the proximal end of thetube will be transmitted to the distal end of the tube; at the sametime, tube 610 also has sufficient flexibility that the tube may bendaround curves in the colon. Furthermore, helical thread 615 has ageometry such that when the camera introducer catheter 600 is positionedwithin the colon, rotation of the proximal end of the catheter willcause helical thread 615 to pull the camera introducer catheter 600along the colon, in the rotate-to-advance fashion of the presentinvention.

As referred to above, camera introducer catheter 600 includes one ormore rotary couplings 605. In one preferred form of the invention, arotary coupling 605 is rotatably attached to the distal end of tube 610,such that the rotary coupling may rotate freely about the axis of thetube while being fixed, longitudinally, to the tube. Additional rotarycouplings 605 may be disposed along the length of tube 610 and endoscope700.

Preferably camera introducer catheter 600 is constructed so as tominimize friction between rotary coupling 605 and tube 610 when tube 610is rotated. For example, low friction bushings or bearings may be used,and/or appropriate lubricants and/or coatings may be applied tocontacting surfaces.

The joinder between tube 610 and/or endoscope 700 and/or rotary coupling605 may be sealed to prevent fluid infiltration. This is particularlyimportant at a distal end of the construction which is the portion mostexposed to fluid ingress. A design addressing this feature may includelabyrinth, point-contact and wiper configurations. See, for example,FIG. 36, where a pair of O-ring seals 620 and 625 seal the constructionagainst fluid penetration.

The camera assembly or endoscope 700 is intended to be secured to rotarycoupling 605 so that the endoscope will be longitudinally fixed tocamera introducer catheter 600 but free to rotate relative to the cameraintroducer catheter. By way of example but not limitation, cameraassembly or endoscope 700 may be mounted to rotary coupling 605 by meansof a set screw 630 which causes a protective ring liner 635 into bindingengagement with endoscope 700. Access to set screw 630 may be through anopening 640 in tube 610.

As a result of the foregoing construction, camera assembly or endoscope700 may be secured to one or more rotary couplings 605 of cameraintroducer catheter 600 whereby, when the camera introducer catheter 600is thereafter placed within the colon and the proximal end of thecatheter's tube 610 is rotated, the distal end of tube 610 will turn,whereby helical thread 615 will pull the catheter (and hence endoscope700) distally along the colon. At the same time, however, inasmuch asrotary coupling 605 is free to rotate with respect to tube 610,endoscope 700 will remain rotationally stationary with respect to therotating catheter. In this way, endoscope 700 may be advanced within thecolon using the rotate-to-advance technique of the present invention,without requiring any corresponding rotation of the endoscope itself. Asa result, the medical practitioner will be able to maintain effectivevisualization of the colon as the endoscope is advanced (or retracted,with reverse rotation) within the colon. Furthermore, inasmuch as theendoscope per se does not to rotate, the endoscope's umbilage connection(e.g., light, electrical, fluid, etc.) are significantly simplified.

If desired, threaded camera introducer catheter 600 may be provided withmultiple rotary couplings, with the additional rotary couplings beingpositioned anywhere along the length of catheter 600. By way of examplebut not limitation, and looking now at FIG. 35, a relatively shortintroducer catheter 600 might utilize a pair of rotary couplings, one(i.e., 605) at the distal end of the catheter and one (i.e., 605A) atthe proximal end of the catheter; a longer introducer catheter 600 mightinclude several additional rotary couplings, with the additional rotarycouplings (i.e., 605B) being disposed between the two end rotarycouplings. In this respect it should be appreciated that rotarycouplings 605 may have varying lengths, depending on their construction.Thus, in one form of the invention, a single rotary coupling 605 mayextend along substantially the entire length of tube 610.

Furthermore, if desired, threaded introducer catheter 600 may includedesign features designed to maximize the tortional stiffness of its tube610 while minimizing bending stiffness of the tube. By way of examplebut not limitation, and looking now at FIG. 37, tube 610 may be formedwith a composite construction comprising an inner convoluted orcorrugated tube 645, with or without a braided fiber layer 650, and withor without flexible outside layer 655. The term “corrugated tube” isintended to denote a tube configured with a plurality of parallel ringsconnected together by recessed floors. The term “convoluted tube” isintended to denote a tube configured with a continuous peak and floorthat runs along the length of the tube in a helical configuration. Thetorsional and bending characteristics of the corrugated or convolutedtube may be optimized by varying the geometry and/or the material alongthe length of the device. Where such a construction is used, one or morelow friction bearings 660 (FIG. 37) may be positioned within thecatheter's interior lumen so as to reduce surface contact with theendoscope (not shown in FIG. 37), where bearings 660 include aprotrusion 665 which is adapted to ride in the helical trough of theconvoluted or corrugated tube 645. Alternatively, and looking now atFIG. 38, one or more low friction bearings 670 may be provided, wherebearings 670 include a recess 675 for receiving the helical peak ofconvoluted corrugated tube 645. Another embodiment utilizes a smoothliner disposed within the internal diameter of the corrugated tube 645so as to reduce friction when a visualization device or instrument isdisposed within the tube. This liner may be composed of multiple layersto allow for bending without kinking, such as an elastic layersupporting a low friction layer. The liner may employ a coating toreduce frictional drag, or be composed of a lubricant blended compound.By way of example but not limitation, one such compound may bepolyethylene oxide which, when hydrated, produces a lubricating film onthe liner surface.

The threaded camera introducer catheter 600 may also include a featureto disconnect the rotary coupling 605 from the endoscope while thecatheter 600 is deployed within the body. This disconnect may beeffected via fluid, mechanical, electrical or other means. See, forexample, FIG. 39, where a fluid line 680 is used to expand and deflate abladder 685 so as to selectively bind and release, respectively, theendoscope 700 to and from rotary coupling 605.

It should also be appreciated that threaded introducer catheter 600 maybe used to deploy objects other than an endoscope 700. For example,introducer catheter 600 may be used to deploy other visualizationapparatus (e.g., ultrasound devices) and other objects which haveumbilage associated therewith, e.g., a fluid dispenser apparatus, avacuum snare, surgical instruments, etc.

Looking next at FIGS. 39A, 39B, 39C and 39D, there is shown a threadedcamera introducer system 710 which comprises a corrugated tube 715having a liner 720 disposed therein and a handle 725 positioned thereon.At the distal end of corrugated tube 715, there is disposed a nose cone730 having helical threads 735 extending therefrom. Nose cone 730 issecured to the distal end of corrugated tube 715, and the helicalthreads 735 are secured to the outer wall of corrugated tube 715. Acollet 740, having a plurality of flexible collet fingers 745, isrotatably mounted to the proximal end of corrugated tube 715. Moreparticularly, collet 740 comprises a plurality of flexible snap lockfingers 750 which (i) flex to receive longitudinal advancement of thecorrugated tube 715 into the collet body, but prevent withdrawaltherefrom, and (ii) permit corrugated tube 715 to rotate relative to thecollet body. A nut 755 threadingly engages collet fingers 745. Nut 755includes an annular inclined surface 760, such that (i) when nut 755 isscrewed distally, collet fingers 745 are driving radially inward, andwhen nut 755 is screwed proximally, collet fingers 745 are permitted torelax radially outwardly. An elastomeric ring 765 is disposed internallyof collet fingers 745. As a result of this construction, an endoscope770 may be inserted within corrugated tube 715, with nose cone 730providing a sliding seal about the perimeter of the endoscope 770. Thennut 755 is screwed distally so as to close collet fingers 745, and henceelastomeric ring 765, into secure engagement with the endoscope 770.Thereafter, handle 725 may be turned whereby to rotate helical threads735 and thereby move the system 710 within a bodily passageway. As thisrotation of corrugated tube 715 occurs, endoscope 770 will be permittedto remain rotationally stationary, due to its ability to rotate withinliner 720 and by virtue of the freedom of collet 740 to rotate freelyrelative to the distal end of corrugated tube 715. Thus, with thisconstruction, liner 720 and collet 740 effectively provide the rotarycoupling which permits endoscope 770 to remain rotationally stationaryeven as corrugated tube 715 rotates to move the system within the bodilypassageway. If it is thereafter desired to free endoscope 770 fromcorrugated tube 715, nut 755 is screwed proximally so as to releasecollet fingers 745, and hence elastomeric ring 765, from grippingengagement with endoscope 770.

It should be appreciated that endoscope 770 may be secured withincorrugated tube 715 so that the distal end of the endoscope projects outof the distal end of corrugated tube 715, so as to expose the angulationportion of the endoscope beyond the distal end of corrugated tube 715.Alternatively, endoscope 770 may be secured within corrugated tube 715so that the distal end of the endoscope projects substantially beyond(e.g., greater than 6 inches or so) the distal end of corrugated tube715.

Conventional Endoscope with Helical Threads

In another form of the invention, and looking now at FIG. 39E, there isshown a rotate-to-advance endoscope 780 which comprises a conventionalendoscope 785 which has helical screw threads 790 along some or all ofthe exterior sidewall 795 of the endoscope, such that upon rotation ofthe endoscope, the helical threads will move the endoscopelongitudinally within a bodily passageway. In other words, in this formof the invention, helical screw threads 790 are disposed on the exteriorsurface of the endoscope itself.

Apparatus for Brachytherapy and Chemotherapy

The treatment of cancerous growths with brachytherapy is welldocumented. One approach is to surgically implant radioactive materialinto the cancerous growth in order to position the radiation source asclose as possible to the target tissue. Such implantation can bedifficult and time-consuming to effect. Furthermore, if the needsubsequently arises to modify the radiation dosage or to limit theexposure to only a short time period, the implantation process can bedifficult to reverse.

Thus, in accordance with the present invention, there is provided novelapparatus for effecting brachytherapy, that is, for directingradioactive material to a target site within the body, while allowingfor easy implantation and removal.

Such novel brachytherapy apparatus may be cannulated or non-cannulated,depending on the anatomy which is to be targeted.

By way of example but not limitation, in one preferred application ofthe novel brachytherapy apparatus, the device may be used for thetreatment of prostate cancer where the radioactive material must bedelivered to the region of the affected prostate gland. In this case, itwill generally be desirable to use a cannulated form of the presentinvention to effect delivery of the radioactive material.

More particularly, in this case, the novel brachytherapy apparatus maycomprise a stent such as the stent 301 shown in FIGS. 16-18, along withits associated threaded stent-follower 341 shown in FIGS. 21 and 22, aswell as its associated stylet 331 shown in FIGS. 19 and 20, except thatthe stent includes radioactive materials RM (FIG. 17) incorporated intoits construction. As a result, when brachytherapy stent 301 is emplacedwithin the urethra adjacent to the target prostate tumor, thebrachytherapy stent may irradiate the tumor so as to effect the desiredbrachytherapy.

By way of further example but not limitation, in another preferredapplication of the novel brachytherapy apparatus, the device may be usedfor the treatment of breast cancer, where the therapeutic radiation mustbe delivered to the breast. In this case, it may be desirable to use anon-cannulated form of the invention.

More particularly, in this case, the novel brachytherapy apparatus maycomprise a threaded solid element such as the dilator 201 shown in FIG.13, except that the dilator may include radioactive materials RM (FIG.13) incorporated into its construction. As a result, when brachytherapydilator 201 is advanced through a mammary canal (accessed through anopening on the nipple) and into the interior of the breast, whereby itmay reside adjacent to a target tumor, the brachytherapy dilator mayirradiate the tumor.

It is also anticipated that the radioactive materials RM of theaforementioned brachytherapy stent 301 and/or the aforementionedbrachytherapy dilator 201 may be replaced by a therapeutic agent capableof leaching out of the wall of the delivery device and thereby bedelivered to the target tumor. Additionally, the therapeutic agent maybe coated onto a wall of the delivery device for delivery to the targetregion.

Conduit Fitting

Looking next at FIG. 40, there is shown a conduit fitting 800 which canbe used to provide a quick and effective access to a corporeal conduitsuch as an artery or vein, etc.

Conduit fitting 800 generally comprises a body 805 and an obturator 810.Body 805 has a helical thread 815 formed on its distal end, and anenlarged flange 820 formed on body 805 proximal to helical thread 815. Acentral lumen 825 extends the length of body 805. A fluid valve 830,preferably in the form of one or more deformable seals, is disposed atthe distal end of the device so as to selectively close off lumen 825.

Obturator 810 is sized to fit within, and close off, lumen 825 of body805. In addition, obturator 810 is adapted to drivingly engage body 805,whereby rotation of obturator 810 may be converted into correspondingrotation of body 805. By way of example but not limitation, obturator810 may be drivingly connected to body 805 by an obturator pin 835 whichengages a pair of body ears 840.

In one contemplated manner of use, a small hole is first made into acorporeal conduit, e.g., a blood vessel. The distal end of body 805,with obturator 810 in place, is then inserted into the hole. Next,obturator 810 is turned so as to cause body 805 to turn, whereuponthread 815 will pull the distal end of body 805 into the interior of theblood vessel. Engagement of flange 820 with the outer surface of theblood vessel will prevent further movement of body 805 into the bloodvessel. Engagement of flange 820 can also assist in sealing the bloodvessel against leakage. To this end, flange 820 may comprise a compliantseal and/or may comprise a thrombogenic agent. Obturator 810 may then beremoved; however, blood will not pass out of the proximal end of body805 due to the presence of fluid valve 830. Thereafter, when instrumentsor the like are to be introduced into the blood vessel by means of body805, they may be pushed through the fluid valve 830 and lumen 825.

When access to the blood vessel is no longer required, body 805 may bebacked out of the blood vessel, e.g., by reinserting obturator 810 intobody 805 so that obturator pin 835 engages body ears 840, and thenappropriately turning the distal end of the obturator so as to unscrewbody 805 from the wall of the blood vessel.

Body 805 is preferable absent of perforations so as to minimize anyingrowth of tissue into the body, which may render subsequent removalmore difficult. Additionally, various materials and/or coatings may beused to minimize tissue ingrowth to body 805.

Access Device

Visual examination of the large intestine (colonoscopy) is performed bypassing a colonoscope, retrograge, the entire length of the intestine,starting at the rectum and advancing to the cecum.

Standard practice is to lubricate the colonoscope and the entry site(i.e., the anal sphincter) prior to inserting the colonoscope with acombination of push-and-quarter turn twisting motion.

This insertion can be especially challenging where the patient is notrelaxed and the sphincter muscle is held tightly closed. Hemorrhoids canalso cause discomfort when the instrument is advanced into the analsphincter. Also, to the extent that a helically-threaded introducer(such as the threaded introducer catheter 500 described above) is usedto deploy the endoscope, the presence of the introducer's helicalthreads can add to the challenge of inserting the colonoscope into therectum.

To this end, and looking now at FIGS. 41-43, a novel access device 900is provided. Access device 900 comprises two main elements, a liner 905having a central lumen 907 and an obturator 910 sized to selectivelyclose off lumen 907.

In use, obturator 910 is first positioned in lumen 907 of liner 905, andthen the assembly is inserted into the rectum. Once access device 900 isinserted in the rectum, obturator 910 is removed, thereby providing atubular access into the rectum. Then the colonoscope (with associatedthreaded introducer catheter 500 if desired) can be passed freely intothe rectum.

Liner 905 may or may not have a helical thread or other surface geometryon the exterior of the tube to help advance the liner into the rectum orto help keep it in place. Additionally, liner 905 may be designed with afeature to cause it to split so it can be easily removed from theprocedure site once the colonoscope has entered the rectum.

Powered Drive

In one preferred form of the present invention, and looking now at FIG.44, there is shown a catheterization system 1000 which comprises athreaded catheter 1005 and a powered drive 1010. The threaded catheter1005 comprises a central lumen 1012 for receiving instrumentstherewithin, e.g., an endoscope 1013. The powered drive 1010 may be usedto rotate the threaded catheter 1005 and thereby advance the threadedcatheter 1005 along the bodily passageway.

The powered drive 1010 can be detachably attached to the threadedcatheter 1005 either before or after the initial insertion of thethreaded catheter 1005 into a bodily passageway. Furthermore, thepowered drive 1010 may be placed anywhere along the length of thethreaded catheter 1005. In one preferred form of the invention, thepower drive is placed at the proximal end of the threaded catheter.

The energy input to the powered drive 1010 may be one source or acombination of sources. By way of example but not limitation, the energysource may comprise electrical, hydraulic, pneumatic, ultrasonic,magnetic and/or other energy sources. It should be appreciated thatthese energy sources may be disposed anywhere along the length ofcatheterization system 1000, or they may be remotely located. The energyfrom the energy source(s) may be transmitted to the rotating helix via apermanent or detachable coupling mechanism. This coupling mechanism ispreferably used in conjunction with the rotary bearing mechanismdisclosed above.

The powered drive 1010 may be constructed in a configuration whichminimizes its external size so as to accommodate the body orifice thatthe device is traversing. Additionally, the powered drive 1010 mayinclude “coreless motors” or “coreless drive mechanisms” which mayprovide a lumen for passing tools, fluids, optical devices, etc. throughthe threaded catheter to the surgical site.

In a preferred embodiment of the present invention, the powered drive1010 may be controlled directly by the physician using user controls1015 (see FIG. 44). Such user controls 1015 may comprise a switchingdevice, such as a momentary switch, which cuts off power to the powereddrive 1010 once the switching device is no longer engaged.Alternatively, the user controls 1015 may comprise a Graphical UserInterface (GUI).

Significantly, the aforementioned switching device may also be designedto reverse the direction of catheter rotation (i.e., clockwise vs.counterclockwise) so as to control advancement and retraction of therotary introducer within the bodily passageway.

In another preferred embodiment of the invention, the aforementionedswitching device may also incorporate a “throttle” feature so as toallow the user to vary the speed of catheter rotation, as well as aforce feedback output so as to give the physician an indication of theamount of resistance the device is encountering as it advances into thebodily passageway. Such a feature may constitute a safety measure thatmay prevent high rotational forces from being inadvertently applied tothe threaded catheter, thereby minimizing risk of injury to the patient.

It will be appreciated that if it is necessary to advance a portion ofthe powered drive 1010 (or even the entirety of the powered drive 1010)into a bodily passageway during use of the present invention, a smalldiameter powered drive 1010 should be used.

The powered drive 1010 may be designed so as to be cleanable andreusable, or powered drive 1010 can be disposable.

It should be appreciated that the powered drive 1010 may be used in asystem additionally comprising conduits extending through the threadedcatheter for air/water/suction and tool passage (as describedhereinabove and/or hereinbelow).

It should also be appreciated that the powered drive 1010 may be usedwith imaging devices which deliver data through the catheter shaft viafiberoptic cables or electrical signals. Alternatively, the imagesignals could be transmitted from the distal end of the catheter to aremote receiver so as to eliminate the need for an electricalconnection. Similarly, the powered drive 1010 may also be remotelycontrolled via a wireless connection.

In another embodiment of the present invention, it is possible toutilize two counterwound helical sections that rotate in oppositedirections so as to eliminate the need for the torsionally rigid spline.This embodiment may be constructed with an integral power supply anddrive mechanism, and a mechanized surgical tool which is remotelycontrolled (i.e., wireless), and a wireless image transmitter so as toenable an untethered instrument. This instrument could be driven into abodily lumen and perform a diagnostic or therapeutic procedure, all viawireless (e.g., remote) control.

A small diameter helical catheter 1005 may be utilized to access otherbodily passages such as the mammalian ducts, bile ducts, or other areasof the body where a flexible shaft approach is advantageous.

Lavage System

To properly examine and treat conditions of the lower gastrointestinaltract, the patient typically undergoes a purging to remove fecal matter.If this procedure is not conducted successfully, it is generally verydifficult to visualize the bodily passageway clearly. This is highlyundesirable, since anatomical abnormalities may be hidden from theendoscope.

In current procedures, the preparation of the patient involves consuminga large volume of liquid and a purging agent such as magnesium citrate.This causes the desired flushing of the intestines, but it is alsoaccompanied by unpleasant cramping for hours after consumption. Patientshave complained that this is one of the worst parts of undergoingflexible endoscopy. In fact, this unpleasant procedure deters somepatients from undergoing colon endoscopy. It should also be noted thatthe alternative, i.e., a colonic enema, is generally not adequate toclear the lumen prior to endoscopy.

To overcome the foregoing deficiencies, a rotate-to-advance cathetersystem 1100 (FIG. 45), comprising a threaded catheter 1105 incorporatinga lavage system, has been developed to clear away debris from the bodilypassageway in front of the endoscope. In one form of the presentinvention, the lavage system comprises two or more lumens 1110 extendingthrough the rotate-to advance catheter 1105. One lumen, 1110A, carriesfluid from a fluid source 1115 to the region at the front of theendoscope 1120 to break up and flush fecal matter 1123 away from thefront of the endoscope. The second lumen, 1110B, withdraws the fluid(and the fecal debris) from the bodily passageway via suction, e.g.,supplied by suction source 1125.

In one embodiment of the invention, to aid the colon cleaning process,jets may be disposed at the indwelling tip of the threaded catheter soas to produce an increased velocity of fluid entering the bodilypassageway. Additionally, these jets may be aimed back into the suctionlumen to create an increased suction to remove fecal matter.

It should be appreciated that the lavage system described hereinabovemay be used in connection with the camera introducer describedhereinabove, and/or it may be used in any procedure requiring theinsertion of a surgical apparatus into a bodily cavity in which cleaningof the cavity is advantageous.

Preferred Urological Stent

Looking next at FIG. 46, there is shown one preferred urological stentconstruction formed in accordance with the present invention.

In one preferred form of the present invention, the urological stent1200 comprises (i) an implant component 1205 (i.e., the stent), (ii) adelivery element 1210 (i.e., the element which delivers the implantcomponent into position), (iii) a connect/disconnect element 1215 (i.e.,the element which allows the delivery and/or retrieval elements tointerface with the stent), and (iv) a retrieval element 1220 (i.e., theelement which enables removal of the stent from the body).

The stent implant of the present invention may comprise a preformed “J”shape, a balloon and/or protrusions 1225 (a balloon 1225 is shown inFIG. 46) at the distal end of the stent which extends into the bladderto prevent the stent from migrating downstream (i.e., away from theurinary bladder) after deployment. In addition, other protrusions 1230are preferably provided on the distal end of the stent. These additionalprotrusions are preferably in the form of fingers, fibers, flaps, discs,etc., and extend outwardly so as to resist migration of the stenttowards the bladder. These additional protrusions 1230 are typicallyconfigured to extend or be exposed after the stent is delivered to theproper location by means of swelling (e.g., liquid absorption), heat,stored energy, electric/electrical signal, ablation, and/or othermethods known in the art.

The delivery is facilitated by providing a helix 1235 on the stent toadvance the stent and the trailing delivery system to the properlocation. The proper location can be confirmed by urine flow, i.e.,urine will flow once the stent extends to the bladder. Alternatively,traditional imaging methods can be used to confirm location (e.g.,x-ray, ultrasound, etc.). When the stent is properly located within theurethra, adjacent to the prostate and on the bladder side of theexternal sphincter, the stent is disconnected from the delivery element1210.

Connecting and disconnecting of the stent 1200 from the delivery 1210and/or retrieval elements 1220 may be conducted via wireless signal,push/pull of a wire or cable, inflation/deflation of a balloon orbladder, screwing/unscrewing of threaded elements, thermalexpansion/contraction, swelling/shrinking, on/off tapered elements,magnetizing/demagnetizing, wrapping/unwrapping elements,sticking/unsticking, grabbing/releasing and/or other methods which willbe apparent to those skilled in the art in view of the presentdisclosure. In this respect it should be noted that the shape of theconnect/disconnect elements 1215 are generally non-circular, and may behexagonal, square, triangular, slotted, star-shaped, hole-with-detent,etc.

It should be noted that during use, metal or non-metal tethers 1240 maybe kept in place at the time of delivery so as to thereafter function,if necessary, as a guide for connecting the retrieval element 1220 tothe stent for removal of the stent 1200. The retrieval element 1220 isguided to the stent by a guide wire which is advanced to the stent 1200in advance of the retrieval element 1220.

In one preferred form of the present invention, the stent may bedisassembled or separated into two or more pieces before removal.

Preferred Fallopian Catheter Construction

Looking next at FIG. 47, there is shown one preferred fallopian catheter1300 formed in accordance with the present invention.

In one preferred form of the present invention, the fallopian catheter1300 comprises a body 1305 having helical threads 1310 formed thereon.Body 1305 and helical threads 1310 are sized for disposition in afallopian tube.

Threaded Camera Introducer System for Small Bowel Applications

Looking next at FIGS. 56-62, there is shown a helically-threaded cameraintroducer system 710A which may be used to access, and position anendoscope 770A within, the small bowel. As discussed above, asignificant advantage of the helical camera introducer system 710A isits ability to control (both longitudinally and rotationally) thevisualization apparatus (e.g., endoscope 770A) within the bodypassageway (i.e., the small bowel) in order to improve visualization anddiagnostic yield, as well as to provide a stable platform for therapy.By way of example but not limitation, helical camera introducer system710A can help stabilize an endoscope during insertion into, andwithdrawal out of, the torturous and delicate anatomy of the smallbowel.

Camera introducer system 710A is generally similar to camera introducer710 discussed above, except that it is specifically configured to beused in small bowel applications, in either antegrade or retrogradefashion, as will hereinafter be discussed in further detail.

More particularly, the helical thread of camera introducer system 710Ais preferably provided with a semi-ovoid cross-sectional thread profile,i.e., the “mailbox” shape shown in FIG. 57. Forming helical thread 735Awith this semi-ovoid, “mailbox” shape allows for an easier and lesstraumatic advancement to, and through, the small bowel. It should beappreciated that helical thread 735A may also be provided withalternative profile geometries in order to optimize desired performancecharacteristics. By way of example but not limitation, camera introducersystem 710A may be provided with (i) a helical thread having anon-symmetrical cross-section, or (ii) a helical thread having a profilewhich varies along the length of the helix, etc.

Furthermore, if desired, the helical thread may be formed so as to bepartially deformable when engaging tissue, so as to provide a morecompliant and less traumatic engagement with the tissue, e.g., during arotate-to-advance procedure or during a rotate-to-pleat procedure. Inother words, the helical thread may be constructed so that it willdeform to some extent when it engages the tissue, whereby to form a morecompliant and less traumatic engagement with the tissue. Of course,while the helical thread is partially deformable, it must still retain asufficient structural integrity to advance the camera introducer systemthrough the anatomy (in a rotate-to-advance procedure) or to pleat thesmall bowel tissue onto the corrugated tube (in a rotate-to-pleatprocedure). By way of example but not limitation, this “partiallydeformable” thread characteristic may be provided by forming the helicalthread with a hollow configuration. See FIG. 57.

In addition to the foregoing, and because camera introducer system 710Amay be advanced using an antegrade approach rather than a retrogradeapproach, the proximal end of the camera introducer system is speciallyconfigured so as to be more appropriate for the application and lesstraumatic to the patient. More particularly, in order to reduce traumato the patient's throat, the proximal end of camera introducer systemmay be fitted with an atraumatic jacket at the location where theproximal end of the camera introducer system will contact the throatduring the procedure.

In use, in an antegrade small bowel procedure, camera introducer system710A is advanced down the esophagus, through the stomach and into thesmall bowel. See FIGS. 56 and 58. Preferably this is done with endoscope770A having been secured within the corrugated tube so that the distalend of the endoscope projects substantially beyond (e.g., by 6 inches orso) the distal end of the corrugated tube.

Once in the small bowel, and looking next at FIGS. 59-62, as the cameraintroducer system 710 is rotated and advanced, the small bowel tissuebegins to gather on the exterior of helical threads 735A. The connectivetissue, or mesentery, of the small bowel is very mobile and allows forthe tissue to easily gather, and essentially “pleat”, onto the shaft ofthe advancing camera introducer system 710A.

By gathering the pleated tissue of the small bowel onto the cameraintroducer system 710A, it is possible for the physician to moreefficiently traverse the approximately 6 meters of small bowel, whichwould be impractical using traditional small bowel endoscope deliverysystems.

Once the camera introducer system has been advanced to a desiredlocation within the small bowel, or to the furthest accessible pointwithin the small bowel, nut 755A can be unlocked by un-screwing itproximally. This opens collet fingers 745A, and hence elastomeric ring765A, thereby releasing endoscope 770A from corrugated tube 715A.Endoscope 770A can thereafter be extended out of the corrugated tube715A and advanced further into the small bowel. Providing cameraintroducer system 710A with this extendable endoscope feature can beparticularly advantageous in difficult to traverse cavities such as thesmall bowel.

It should be appreciated that camera introducer system 710Asignificantly shortens the length of time required for the physician toaccess and traverse the small bowel. By having the small bowel tissuegather in a pleating fashion along helical threads 735A, the surgeon isable to advance the apparatus through the small bowel in less than halfthe time required by traditional devices and methods. This issignificant as shortening procedure time (i) reduces the length of timethat the delicate small bowel tissue is pleated on itself (and hencesubject to damage or necrosis), (ii) reduces the total length of timethat the patient needs to be under anesthesia, and (iii) allowsphysicians to perform more of these procedures for other patients inneed.

Threaded Camera Introducer System with Powered Helical Drive LocatedIntermediate the Length of the Camera Introducer System

In the foregoing description, the rotate-to-advance catheterizationsystem generally comprises an elongated tube having helical threadsdisposed thereon, wherein substantially the entire length of the tube isrotated in order to effect the desired rotate-to-advance action. By wayof example but not limitation, and looking now at FIG. 63, threadedcamera introducer system 710A generally comprises a tube 715A havinghelical threads 735A disposed thereon, wherein substantially the entirelength of tube 715A is rotated in order to effect the desiredrotate-to-advance action.

In another form of the present invention, and looking next at FIG. 64,there is shown a novel threaded camera introducer system 710B which isgenerally similar to threaded camera introducer system 710A discussedabove, except that it is formed with a powered helical drive locatedintermediate the length of the threaded camera introducer system.

More particularly, in this form of the present invention, novel threadedcamera introducer system 710B comprises a shaft S which preferablycomprises three zones: a non-rotating distal zone 51, a rotatableintermediate zone S2, and a non-rotating proximal zone S3. An endoscope770B preferably extends some distance beyond the distal end ofnon-rotating distal zone 51, in the manner shown in FIG. 64. Rotatableintermediate zone S2 carries helical thread 735B. Power for rotatingrotatable intermediate zone S2 is transmitted from the proximal end ofthreaded camera introducer system 710B, through non-rotating proximalzone S3, to rotatable intermediate zone S2. By way of example but notlimitation, power may be transmitted to rotatable intermediate zone S2via a hollow rotatable tube disposed co-axial with, and in-board of,non-rotating proximal zone S3. Alternatively, and as discussed above,power may be transmitted to rotatable intermediate zone S2 by a varietyof sources located anywhere along the length of the catheterizationsystem.

In use, threaded camera introducer system 710B is advanced to the smallbowel (or other bodily passageway) in the same way as threaded cameraintroducer system 710A. Once threaded camera introducer system 710B isadvanced into the small bowel (or other bodily passageway), rotatableintermediate zone S2 is rotated so as to cause helical threads 735B togather, and pleat, small bowel (or other bodily passageway) tissue overnon-rotating proximal zone S3. When it is desired to un-pleat thegathered small bowel (or other bodily passageway) tissue fromnon-rotating proximal zone S3, rotatable intermediate zone S2 may simplybe rotated with the opposite rotation.

If desired, non-rotating distal zone S1 may be formed so as to berelatively short, and non-rotating proximal zone S3 may be formed so asto relatively long.

Or, if desired, non-rotating distal zone S1 may be omitted altogether,in which case shaft S comprises only two zones, a rotatable distal zoneand a non-rotating proximal zone.

If desired, a torque limiter may also be provided so as to safeguard thetissue.

Furthermore, if desired, more than one rotatable intermediate zone S2can be provided along the length of the shaft, preferably separated byzones of non-rotatable shaft. And, if desired, combinations of left-handand right-hand rotation of rotatable intermediate zone S2 can beprovided along the length of the shaft for selectively engagingdifferent regions of tissue, e.g., one rotatable zone may be configuredto engage the large bowel and another rotatable zone may be configuredto engage the small bowel. Where multiple rotatable intermediate zonesS2 are provided, it is important to note that each zone may be operatedat the same time as the remaining rotatable intermediate zones S2, oreach of the multiple rotatable intermediate zones S2 may be rotatedindependently of one another. By way of example but not limitation, twoseparately-operable rotatable intermediate zones S2 may be providedalong the length of the shaft, with the proximalmost rotatableintermediate zone S2 configured to engage the large bowel so as toadvance the shaft along the large bowel and with the distalmostrotatable intermediate zone S2 configured to engage the small bowel soas to plicate the small bowel onto the shaft.

As discussed above, once threaded camera introducer system 710B isadvanced into the small bowel (or other bodily passageway), rotatableintermediate zone S2 is rotated so as to cause helical threads 735B togather, and pleat, small bowel (or other bodily passageway) tissue overnon-rotating proximal zone S3. In contrast, as a traditional one piecethreaded camera introducer system (e.g., FIG. 63) is advanced throughthe small bowel (or other bodily passageway), the entire length of thethreaded camera introducer is rotated, thereby causing the helicalthreads to gather, and pleat, small bowel (or other bodily passageway)tissue over the entire length of the threaded camera introducer. Becausethe entire length of the threaded camera introducer is rotating,friction can build between the threaded camera introducer system and theplicated tissue as more and more tissue is plicated onto the threadedcamera introducer system. This friction can eventually limit how much ofthe small bowel (or other bodily passageway) tissue can be plicated ontothe threaded camera introducer system and can make it increasinglydifficult to navigate, and advance through, the tortuous paths of thesmall bowel (or other bodily passageway). By constructing threadedcamera introducer system with rotatable intermediate zone S2 andnon-rotating distal zone S1 and non-rotating proximal zone S3, the smallbowel (or other bodily passageway) may be gathered onto non-rotatingproximal zone S3 as the threaded camera introducer system is advancedwithout progressively increasing friction between the tissue and thenon-rotating proximal zone S3 which receives that tissue.

It should also be appreciated that the foregoing construction can beintegrated into the design of the endoscope itself. More particularly,and looking now at FIGS. 65-73, there is shown a novel endoscope 1500which comprises an elongated shaft 1505. Elongated shaft 1505 in turncomprises three zones: a non-rotating distal zone 1510, a rotatableintermediate zone 1515 and a non-rotating proximal zone 1520. Rotatableintermediate zone 1515 carries helical threads 1525. Power for rotatingrotatable intermediate zone 1515 is transmitted from the proximal end ofendoscope 1500, through non-rotating proximal zone 1520, to rotatableintermediate zone 1515. By way of example but not limitation, power maybe transmitted to rotatable intermediate zone 1515 via a hollowrotatable tube disposed co-axial with, and in-board of, non-rotatingproximal zone 1520. Alternatively, and as discussed above, power may betransmitted to rotatable intermediate zone 1515 by a variety of sourceslocated anywhere along the length of the catheterization system.

In one preferred form of the invention, and looking now at FIG. 74, itwill be seen that a geared drive shaft assembly 1530 may be used to turnrotatable intermediate zone 1515. More particularly, geared drive shaftassembly 1530 generally comprises a flexible drive shaft 1535 fordelivering rotational motion to the distal end of proximal non-rotatingzone 1520, a circumferential gear 1540 secured to the inner surface of ajacket 1545 which carries helical threads 1525 thereon, and a pair oftransmission gears 1550 for transferring motion between flexible driveshaft 1535 and circumferential gear 1540. As a result of thisconstruction, rotation of flexible drive shaft 1535 rotates jacket 1545,which in turn rotates helical threads 1525.

In practice, it may be found that when endoscope 1500 is passed asubstantial length along a tortuous bodily passageway, so that theelongated shaft 1505 of the endoscope must traverse numerous twists andturns, it may be desirable or necessary to provide a spline connectionalong flexible drive shaft 1535 so as to accommodate changes of cablelength due to bending of the endoscope.

In use, endoscope 1500 is advanced to the small bowel (or other bodilypassageway) in the same way as threaded camera introducer system 710A.Once endoscope 1500 is advanced into the small bowel (or other bodilypassageway), rotatable intermediate zone 1515 is rotated so as to causehelical threads 1525 to gather, and pleat, small bowel (or other bodilypassageway) tissue over non-rotating proximal zone 1520. When it isdesired to un-pleat the gathered small bowel (or other bodilypassageway) tissue from non-rotating proximal zone 1520, rotatableintermediate zone 1515 may simply be rotated with the opposite rotation.

Again, if desired, non-rotating distal zone 1510 may be omittedaltogether, in which case shaft 1505 comprises only two zones, arotatable distal zone 1515 and a non-rotating proximal zone 1520.

In one preferred form of the present invention, and looking now at FIGS.75-87, there is provided a novel visualization system 1600 formed inaccordance with the present invention. Novel visualization system 1600may be used to examine, diagnose and/or treat tissue located within, oraccessed via, a bodily passageway, e.g., the large bowel, the smallbowel, etc. Novel visualization system 1600 is believed to haveparticular application to examining, diagnosing and/or treating tissuelocated within, or accessed via, the small bowel, with the small bowelbeing plicated and/or pleated upon the outer surface of the novelvisualization system so as to facilitate access to deep distal sites.

Still looking now at FIGS. 75-87, novel visualization system 1600generally comprises an endoscope 1605 and a disposable drive tube 1610.More particularly, endoscope 1605 comprises a rotatable drive collar1615, and disposable drive tube 1610 comprises one or more helicalthreads 1620, with disposable drive tube 1610 being removably attachableto rotatable drive collar 1615, whereby endoscope 1605 can causedisposable drive tube 1610 to rotate so that helical threads 1620 causerelative movement between passageway tissue and the endoscope. In thisway, endoscope 1605 can access tissue at deep distal sites.

More particularly, endoscope 1605 includes a flexible drive shaft 1625for delivering rotary motion to the distal end of the drive tube. A pairof transmission gears 1630, 1635 transfer motion between flexible driveshaft 1625 and rotatable drive collar 1615. As a result of thisconstruction, rotatable drive collar 1615 can be rotatably driven,either clockwise or counterclockwise, by applying appropriate rotarymotion to the proximal end of flexible drive shaft 1625.

Disposable drive tube 1610 comprises an elongated tube 1640 having oneor more helical threads 1620 disposed on its outer surface. Helicalthreads 1620 are of the sort previously disclosed, i.e., when helicalthreads 1620 engage the interior wall of a bodily passageway (e.g., thesmall bowel, the large bowel, etc.), rotary motion of helical threads1620 will cause relative movement between passageway tissue and thedrive tube (and hence the endoscope). In this way, rotation ofdisposable drive tube 1610 can cause advancement or withdrawal ofendoscope 1605 along the bodily passageway, and/or movement ofpassageway tissue along the endoscope (so as to plicate and/or pleat thetissue onto the endoscope).

Disposable drive tube 1610 is intended to be releasably mounted torotatable drive collar 1615 of endoscope 1605. In one preferred form ofthe invention, disposable drive tube 1610 is releasably mounted torotatable drive collar 1615 by a bayonet mount. More particularly, inthis form of the invention, disposable drive tube 1610 includes anextension 1641 having a radially-extending pin 1650 mounted thereto. Ashoulder 1651 is formed distal to the radially-extending pin 1650. Acompression spring 1655 biases a ring 1645 proximally, away fromshoulder 1651. Correspondingly, rotatable drive collar 1615 comprises ashoulder 1659 for opposing ring 1645, and a C-shaped slot 1660 forreceiving pin 1650. More particularly, C-shaped slot 1660 comprises afirst proximally-extending section 1665, a secondcircumferentially-extending section 1670, and a third distally-extendingsection 1675. In view of this construction, when disposable drive tube1610 is to be mounted to rotatable drive collar 1615, the proximal endof disposable drive tube 1610 is slipped over the distal end ofendoscope 1605 and moved proximally until radially-extending pin 1650engages shoulder 1659. Then, with proximally-directed pressure beingapplied to disposable drive tube 1610, the disposable drive tube isrotated circumferentially until pin 1650 slips into the firstproximally-extending section 1665 of C-shaped slot 1660 and ring 1645engages shoulder 1659. Then more proximally-directed pressure is appliedso that the power of compression spring 1655 is overcome andradially-extending pin 1650 moves along first proximally-extendingsection 1665 of C-shaped slot 1660. Then, while maintaining proximalpressure, disposable drive tube 1610 is rotated circumferentially sothat pin 1650 moves along second circumferentially-extending section1670 and is aligned with third distally-extending section 1675. Thenproximal pressure on disposable drive tube 1610 is relaxed so thatcompression spring 1655 moves disposable drive tube 1610 distally sothat pin 1650 moves down third, distally-extending section 1675, wherebyto secure disposable drive tube 1610 to rotatable drive collar 1615.Disposable drive tube 1610 may be removed from endoscope 1605 in acorresponding manner, i.e., by pushing disposable drive tube 1610proximally, rotating disposable drive tube 1610 circumferentially, andreleasing the proximal pressure on disposable drive tube 1610 so thatpin 1650 exits C-shaped slot 1660.

If desired, a pair of diametrically-opposed pins 1650, and acorresponding pair of diametrically-opposed C-shaped slots 1660, can beprovided so as to create a more secure bayonet mount.

In use, a disposable drive tube 1610 is mounted to endoscope 1605, theendoscope is introduced into a bodily passageway, flexible drive shaft1625 is turned in a first direction so as to turn rotatable drive collar1615 and hence disposable drive tube 1610. As a result, relativemovement will be produced between the passageway tissue and thedisposable drive tube (and hence the endoscope), i.e., advancement (orwithdrawal) of the endoscope 1605 along the bodily passageway, and/ormovement of the passageway tissue onto (or off of) the endoscope. Whenthe distal end of endoscope 1605 has accessed the remote site, theendoscope may be used in ways well known in the art to examine, diagnoseand/or treat tissue located within, or accessed via, the bodilypassageway. Thereafter, the endoscope may be withdrawn from the remotesite by rotating flexible drive shaft 1625 in a second, oppositedirection. After the apparatus has been withdrawn from the body,disposable drive tube 1610 may be dismounted from endoscope 1605 anddiscarded.

In one form of the present invention, helical threads 1620 may bedeformable.

More particularly, investigating the small bowel requires that avisualization system navigate through narrow and torturous spaces as itadvances to the small bowel. In some cases, it may be desirable toprovide a visualization system with a deformable helical thread which iscapable of assuming (i) a reduced profile in order to facilitatenavigation to the small bowel, and (ii) an enlarged profile in order tothereafter provide the desired rotate-to-advance action within the smallbowel. A visualization system with a deformable helical thread can alsobe used to traverse bodily passageways other than the small bowel, e.g.,a visualization system with a deformable helical thread can also be usedto traverse other portions of the gastrointestinal tract, the urinarytract, etc.

To this end, visualization system 1600 is preferably provided with adeformable helical thread 1620, in the form of a hollow, and inflatable,helical thread 1620, so as to be capable of achieving the aforementionedreduced profile, and the aforementioned enlarged profile, as desired.

Deformable helical threads 1620 are configured so as to provide areduced profile during navigation to the small bowel or other bodilypassageway. Once in the small bowel (or other bodily passageway), thisreduced profile thread can thereafter be inflated so as to assume theenlarged “rotate-to-advance” profile necessary to gather, or pleat, thesmall bowel (or other bodily passageway) tissue. The reduced profilethread of deformable helical thread 1620 provides less traumaticengagement with tissue during navigation to the small bowel (or otherbodily passageway). However, it is important to note that once thevisualization system is in the small bowel (or other bodily passageway),and deformable helical thread 1620 has assumed its enlarged profile,deformable helical thread 1620 must retain a sufficient structuralintegrity to advance the visualization system through the anatomy (in arotate-to-advance procedure) or to pleat the small bowel (or otherbodily passageway) tissue onto the visualization system (in arotate-to-pleat procedure).

It should also be appreciated that deformable helical threads 1620 maybe inflated by a variety of means. By way of example but not limitation,helical threads 1620 may be inflated (i) by delivering an appropriateinflating material (e.g., various liquids, gases or solids) to theinterior of helical thread 1620, e.g., via one or more conduitsconnected to the helical thread, (ii) by a fluid that expands wheninfluenced by an energy source (e.g., body heat or electricity), etc. Byway of example but not limitation, helical threads 1620 may be inflatedby means of a longitudinally-extending conduit 1680 which extendsthrough endoscope 1605 and which communicates with an opening 1682formed in the wall of the endoscope and with an opening 1684 formed inthe base of helical threads 1620, by which an inflating material may beintroduced into the interior of deformable helical threads 1620.Preferably, a pair of o-rings 1686, carried by a mount 1688 formed inthe sidewall of disposable drive tube 1610, ensures that the inflatingmaterial is constrained as it advances from longitudinally-extendingconduit 1680 into the interior of helical threads 1620.

In one exemplary form of use, visualization system 1600 is advanced tothe small bowel or other bodily passageway in substantially the samemanner as threaded camera introducer system 710A discussed above. Oncein the small bowel (or other bodily passageway), deformable helicalthreads 1620 are inflated, e.g., via the aforementionedlongitudinally-extending conduit 1680. After inflating deformablehelical threads 1620, as visualization system 1600 is rotated, the smallbowel (or other bodily passageway) tissue begins to gather on theexterior of helical threads 1620.

It should be appreciated that deformable helical threads 1620 areconfigured so as to be selectively deflatable as well as selectivelyinflatable. Such deflation may be accomplished by withdrawing theinflating material from helical threads 1620 via the aforementionedlongitudinally-extending conduit 1680. This ability to deflate helicalthreads 1620 can be highly advantageous in situations where thevisualization system is to be removed from the small bowel (or otherbodily passageway) and/or when the visualization system becomes lodgedin the small bowel (or other bodily passageway). This ability to deflatehelical threads 1620 can also be advantageous in an emergency situation,inasmuch as the deformable helical threads may be rapidly deflated andthe visualization system quickly removed from the small bowel (or otherbodily passageway).

It should also be appreciated that deformable helical threads 1620 maybe deflated by a variety of means. By way of example but not limitation,helical threads 1620 may be deflated through the application of suctionat the proximal end of visualization system 1600, or by passing asufficient amount of pressure through visualization system 1600 to causethe inflating material to exit through an opening (e.g., channel) formedin the distal end of helical threads 1620.

Furthermore, where the inflating material is a solid, helical threads1620 may be deflated by passing a liquid (e.g., water) throughvisualization system 1600 in order to dissolve the inflating materialcontained within helical threads and then withdraw the solutionproximally (or eject the solution distally). More particularly, in oneembodiment, deformable helical threads 1620 may be filled with a solid(e.g., a powder) which may be dissolved by a liquid (e.g., water) into aliquid or gel-like consistency which can be withdrawn proximally (orexpelled distally).

It is important to note that if the inflating material is expelled intoa body lumen, the inflating material must be biocompatible so that itcan be safely received within the body lumen after expulsion from thevisualization system.

It should also be appreciated that helical threads 1620 may be formedfrom a variety of materials, or attached to visualization system 1600 bya variety of means, so that helical threads 1620 may be quickly removedfrom the remainder of the visualization system. In one embodiment,helical threads 1620 may comprises a hollow or solid spiral whichdissolves within the body lumen after it has been detached fromvisualization system 1600. Alternatively, helical threads 1620 may beformed out of a dissolvable material (e.g., corn starch) which may becoated with a layer of water resistant material. A liquid (e.g., water)may then be infused via a lumen to dissolve the helical thread forwithdrawal without rotation.

In another embodiment, helical threads 1620 may be magnetically attachedto visualization system 1600.

In another embodiment, the minor diameter of the helical thread may beraised to a level which is equal to, or greater than, the major diameterof the helical thread, thereby resulting in the creation of a structureof uniform height, whereby to facilitate withdrawal of the visualizationsystem from the body.

In still another embodiment, helical threads 1620 may comprise a hollowor solid spiral which is constructed out of multiple smaller tubes. Thesmaller tubes are held together with an adhesive or a solvent. Thehelical thread dissolves into its constituent components (e.g., thesmaller tubes) when exposed to a material which alters the bindingproperties of the adhesive or bonding material.

In yet another embodiment, helical threads 1620 may comprise a hollow orsolid spiral which is constructed out of multiple pieces that can beseparate into many smaller pieces which can then be passed through thegastrointestinal tract when disconnected from visualization system 1600.

In still another embodiment, helical threads 1620 may be detached fromvisualization system 1600 and left in the body for a period of time inorder to dispense drugs, take pictures or video to monitor healingprogress, etc. The helical threads may comprise a tether for maneuveringthe helical threads through the body lumen once the helical threads havebeen detached from visualization system 1600.

Preferred Helical Thread Constructions

The foregoing preferred embodiments of the present invention may includea number of additional designs which can improve the effectiveness ofthe rotate-to-advance catherization system. These additional designs mayrelate to the helical thread construction.

As noted above, the thread height of the helix may vary over its lengthas an aid to the advancement and retention characteristics of the device(see, for example helix 1400 disposed on shaft 1405 in FIG. 48), and maytaper in height at various locations to optimize advancement andanchoring (see, for example, FIG. 49). Additionally, and in accordancewith a further embodiment of the present invention, the helix may beconstructed with an interrupted thread or a series of thread segments inorder to produce the desired advancement and anchoring functions (see,for example, FIG. 50). The thread element may be affixed to the tube ormay be molded integrally on the diameter of a tubular member which ispositioned onto the tubular device. The tubular member, or sections ofthe member, may be sized to provide radial compression once positionedon the device to effect retention during use. Alternatively the threadmay be overmolded directly onto a tubular device.

Preferred Variable Pitch Helix Construction

In accordance with a further embodiment of the present invention, thehelix may be constructed with at least two different thread pitchesalong the length of a device so as to produce different tissue (ormaterial) movement relative to the device (see, for example helix 1400disposed on shaft 1405, FIG. 51). By way of example, a variable pitchhelix construction may be advantageous in gathering the redundant colonover an endoscope or facilitating the removal of waste material withinthe colon. Additionally, a variable pitch helix construction may beutilized to optimize the anchoring of a device within the anatomy.

Preferred Thread Surface Geometry

In another preferred embodiment of the present invention, the threadsurface of the helix may be constructed with protrusions and/or recesseson the surface so as to improve advancement or anchoring of a device(see, for example, FIGS. 52 and 53 which show protrusions 1410 on helix1400).

If desired, this geometry may be encapsulated within bioabsorbable ortemporary material to change the surface geometry after insertion withinthe body. See, for example, FIGS. 54 and 55 which show the helix 1400formed out of absorbable material 1415 and non-absorbable material 1420.

The thread cross-section may also be non-symmetrical with respect to thevertical centerline to enhance the advancement or anchoring within abodily lumen. The shape may be designed to allow the thread to deflectin a beneficial manner so as to improve performance.

Properties of Thread Material

As noted above, the thread element may be solid, hollow and/orfluid-filled. It may be constructed with rigid, elastomeric, or acombination of materials. By way of example but not limitation, thethread elements may be formed out of PVC, polyurethane, TPE, silicone,TFEs, medical grade stainless steel, tantalum, titanium, nickel-titaniumalloy, etc. Conversely, materials may be specifically chosen to bebioabsorable so as to obviate the need for removal of the thread elementof the helix. Alternatively, the thread element may be constructed outof at least two materials having different properties so as to obtaindesired composite properties, such as, for example, hardness, friction,compliance, and/or radiopacity.

Helix Device Incorporating Sensors

In another preferred embodiment of the present invention, the helixdevice may comprise one or more sensors so as to indicate conditionssuch as temperature, pressure, radiation, position and/or any otherstatus for diagnostic or therapeutic treatment during the procedure.

Rotary Coupling Design

In another preferred embodiment of the present invention, a coupling maybe fixed to the endoscope or device with a variety of methods. Theattachment force may be, for example, mechanical, hydraulic, pneumatic,magnetic, and/or adhesive. Or a radial force design may be used,utilizing a deformable element to create a frictional clamping, whichcan be reversed to unlock the coupling. A coupling may be provided whichincorporates a uni-directional clutch to permit rotation in a singledirection (i.e., clockwise only or counterclockwise only). In oneembodiment, the clutch direction may be changed by the operator tofacilitate advancement in one direction and withdrawal by rotating inthe opposite direction. In another embodiment, a one-way override clutchmay utilize a wrapped left-handed spring. This will allow the device tobe advanced and the clutch disengaged for withdrawal by unwinding thespring a fraction of a turn to increase the ID and prevent gripping.Other commonly known clutch designs could also be integrated within thecoupling.

Rotational Aides

An ergonomic grip or grips may be incorporated into the length of thecatheter system to facilitate rotation of the helical device. Thesegrips may be permanent or temporary, such as peel-away, so they can beremoved or relocated during the procedure. The grips may be elastomericor rigid and sized to fit comfortably in the hand. They may also beintegrated with a powered drive within the grip.

Further Constructions

It will be appreciated that still further embodiments of the presentinvention will be apparent to those skilled in the art in view of thepresent disclosure. It is to be understood that the present invention isby no means limited to the particular constructions herein disclosedand/or shown in the drawings, but also comprises any modifications orequivalents within the scope of the invention.

What is claimed is:
 1. A method for visualizing the interior of a bodilypassageway at a remote location, the method comprising the steps of:providing a visualization system for deployment in the bodilypassageway, the visualization system comprising: an endoscope comprisinga rotatable drive collar configured for rotation relative to theendoscope; a disposable drive tube comprising an elongated tube having adeformable helical thread disposed on an exterior surface of theelongated tube, the elongated tube being configured for coaxialdisposition about the endoscope; and a mount for releasably securing thedisposable drive tube to the rotatable drive collar of the endoscope;wherein (i) the deformable helical thread is operable such that thedeformable helical thread transforms between a reduced profileconfiguration and an expanded profile configuration, and (ii) when inits expanded profile configuration, the deformable helical thread has asufficient structural integrity, and a sufficient surface profile, suchthat when the disposable drive tube is disposed in the bodily passagewayso that the deformable helical thread engages the interior side wall ofthe bodily passageway, rotation of the disposable drive tube will inducea relative movement between the disposable drive tube and the side wallof the bodily passageway; mounting the disposable drive tube coaxiallyabout the endoscope so that the disposable drive tube is secured to therotatable drive collar of the endoscope; inserting the visualizationsystem into the bodily passageway at a location remote from the sitewhich is to be visualized, with the deformable helical thread being inthe reduced profile configuration; transforming the deformable helicalthread into the expanded profile configuration; rotating the disposabledrive tube so as to bring together the site which is to be visualizedand the visualization apparatus; and using the visualization apparatusto visualize the interior of the bodily passageway.
 2. A methodaccording to claim 1 wherein the visualization system comprises aflexible drive shaft for rotating the rotatable drive collar, whereinthe flexible drive shaft extends between the proximal end of theendoscope and the rotatable drive collar.
 3. A method according to claim2 wherein the flexible drive shaft is disposed within the endoscope. 4.A method according to claim 2 wherein the visualization system comprisesa motor for rotating the flexible drive shaft.
 5. A method according toclaim 1 wherein the distal end of the endoscope protrudes from thedisposable drive tube when the disposable drive tube is mounted to therotatable drive collar.
 6. A method according to claim 1 wherein themount comprises a bayonet mount.
 7. A method according to claim 6wherein the bayonet mount comprises a pin on one of the disposable drivetube and the rotatable drive collar, and a slot on the other of thedisposable drive tube and the rotatable drive collar.
 8. A methodaccording to claim 1 wherein the bodily passageway comprises thegastrointestinal tract.
 9. A method according to claim 8 wherein thevisualization system is inserted into the small bowel.
 10. A methodaccording to claim 8 wherein the bodily passageway comprises one fromthe group consisting of the small bowel, the colon, the genitourinarytract, and a man-made passageway.
 11. A method according to claim 8wherein the visualization system is inserted in an antegrade fashion.12. A method according to claim 8 wherein the visualization system isinserted in a retrograde fashion.
 13. A method according to claim 1wherein rotation of the disposable drive tube causes a portion of thebodily passageway to be drawn onto the visualization system.
 14. Amethod according to claim 1 wherein rotation of the disposable drivetube causes the visualization system to be advanced along the bodilypassageway.
 15. A method according to claim 1 wherein the deformablehelical thread is hollow, and further wherein the deformable helicalthread is transformed into the expanded profile configuration byintroducing an inflating material into the interior of the helicalthread.
 16. A method according to claim 15 wherein the inflatingmaterial comprises a liquid.
 17. A method according to claim 15 whereinthe inflating material comprises a gas.
 18. A method according to claim15 wherein the inflating material comprises a solid.
 19. A methodaccording to claim 1 comprising the additional steps of: transformingthe deformable helical thread from its expanded profile configuration toits reduced profile configuration; and withdrawing the visualizationsystem from the bodily passageway.
 20. A method according to claim 19wherein the deformable helical thread is hollow, and the interior of thedeformable helical thread comprises an inflating material when thedeformable helical thread is in its expanded profile configuration. 21.A method according to claim 20 wherein the inflating material iswithdrawn from the deformable helical thread when the deformable helicalthread is transformed to its reduced profile configuration.
 22. A methodfor visualizing the interior of a bodily passageway at a remotelocation, the method comprising the steps of: providing a visualizationsystem for deployment in the bodily passageway, the visualization systemcomprising: an endoscope comprising a rotatable drive collar configuredfor rotation relative to the endoscope; a disposable drive tubecomprising an elongated tube having a deformable helical thread disposedon an exterior surface of the elongated tube, the elongated tube beingconfigured for coaxial disposition about the endoscope; and a mount forreleasably securing the disposable drive tube to the rotatable drivecollar of the endoscope; wherein (i) the deformable helical thread isoperable such that the deformable helical thread transforms between areduced profile configuration and an expanded profile configuration, and(ii) when in its expanded profile configuration, the deformable helicalthread has a sufficient structural integrity, and a sufficient surfaceprofile, such that when the disposable drive tube is disposed in thebodily passageway so that the deformable helical thread engages theinterior side wall of the bodily passageway, rotation of the disposabledrive tube will induce a relative movement between the disposable drivetube and the side wall of the bodily passageway; mounting the disposabledrive tube coaxially about the endoscope so that the disposable drivetube is secured to the rotatable drive collar of the endoscope;inserting the visualization system into the bodily passageway at alocation remote from the site which is to be visualized; rotating thedisposable drive tube so as to bring together the site which is to bevisualized and the visualization apparatus; using the visualizationapparatus to visualize the interior of the bodily passageway;transforming the deformable helical thread to the reduced profileconfiguration; and withdrawing the visualization system from the bodilypassageway.
 23. Apparatus for visualizing tissue, the apparatuscomprising: an endoscope comprising a rotatable drive collar configuredfor rotation relative to the endoscope; a disposable drive tubecomprising an elongated tube having a deformable helical thread disposedon an exterior surface of the elongated tube, the elongated tube beingconfigured for coaxial disposition about the endoscope; and a mount forreleasably securing the disposable drive tube to the rotatable drivecollar of the endoscope; wherein (i) the deformable helical thread isoperable such that the deformable helical thread transforms between areduced profile configuration and an expanded profile configuration, and(ii) when in its expanded profile configuration, the deformable helicalthread has a sufficient structural integrity, and a sufficient surfaceprofile, such that when the disposable drive tube is disposed in thebodily passageway so that the deformable helical thread engages theinterior side wall of the bodily passageway, rotation of the disposabledrive tube will induce a relative movement between the disposable drivetube and the side wall of the bodily passageway; and wherein thedisposable drive tube is mounted coaxially about the endoscope so thatthe disposable drive tube is secured to the rotatable drive collar ofthe endoscope.
 24. Apparatus according to claim 23 wherein the apparatuscomprises a flexible drive shaft for rotating the rotatable drivecollar, wherein the flexible drive shaft extends between the proximalend of the endoscope and the rotatable drive collar.
 25. Apparatusaccording to claim 24 wherein the flexible drive shaft is disposedwithin the endoscope.
 26. Apparatus according to claim 24 wherein thevisualization system comprises a motor for rotating the flexible driveshaft.
 27. Apparatus according to claim 23 wherein the distal end of theendoscope protrudes from the disposable drive tube when the disposabledrive tube is mounted to the rotatable drive collar.
 28. Apparatusaccording to claim 23 wherein the mount comprises a bayonet mount. 29.Apparatus according to claim 28 wherein the bayonet mount comprises apin on one of the disposable drive tube and the rotatable drive collar,and a slot on the other of the disposable drive tube and the rotatabledrive collar.
 30. Apparatus according to claim 23 wherein the deformablehelical thread comprises a hollow construction.
 31. Apparatus accordingto claim 23 wherein the deformable helical thread has a semi-ovoidcross-sectional thread profile.
 32. Apparatus according to claim 23wherein the deformable helical thread has a non-symmetricalcross-section.
 33. Apparatus according to claim 23 wherein thedeformable helical thread has a profile which varies along the length ofthe helix.
 34. Apparatus according to claim 30 wherein the deformablehelical thread is transformed into the expanded profile configuration byintroducing an inflating material into the interior of the helicalthread.
 35. Apparatus according to claim 34 wherein the inflatingmaterial comprises a liquid.
 36. Apparatus according to claim 34 whereinthe inflating material comprises a gas.
 37. Apparatus according to claim34 wherein the inflating material comprises a solid.
 38. Apparatusaccording to claim 34 wherein the deformable helical thread istransformed into its reduced profile configuration by withdrawing theinflating material from the interior of the helical thread. 39.Apparatus for inducing relative movement between an endoscope and theside wall of a bodily passageway within which the endoscope is disposed,wherein the endoscope comprises a rotatable drive collar configured forrotation relative to the endoscope, the apparatus comprising: adisposable drive tube comprising an elongated tube having a deformablehelical thread disposed on an exterior surface of the elongated tube,the elongated tube being configured for coaxial disposition about theendoscope; and means for releasably securing the disposable drive tubeto the rotatable drive collar of the endoscope; wherein (i) thedeformable helical thread is operable such that the deformable helicalthread transforms between a reduced profile configuration and anexpanded profile configuration, and (ii) when in its expanded profileconfiguration, the deformable helical thread has a sufficient structuralintegrity, and a sufficient surface profile, such that when thedisposable drive tube is disposed in the bodily passageway so that thedeformable helical thread engages the interior side wall of the bodilypassageway, rotation of the disposable drive tube will induce a relativemovement between the disposable drive tube and the side wall of thebodily passageway; and wherein the disposable drive tube is mountedcoaxially about the endoscope so that the disposable drive tube issecured to the rotatable drive collar of the endoscope.
 40. Apparatusaccording to claim 39 wherein the deformable helical thread isexternally-operable such that the deformable helical thread transformsbetween the reduced profile configuration and the expanded profileconfiguration.
 41. Apparatus according to claim 40 wherein thedeformable helical thread is configured to communicate with alongitudinally-extending conduit.
 42. Apparatus according to claim 23wherein the deformable helical thread is externally-operable such thatthe deformable helical thread transforms between the reduced profileconfiguration and the expanded profile configuration.
 43. Apparatusaccording to claim 42 wherein the deformable helical thread isconfigured to communicate with longitudinally-extending conduit. 44.Apparatus according to claim 43 wherein the longitudinally-extendingconduit extends through the endoscope.